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General NPI Number Information
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NPI Number | 1457530388
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Entity Type | Organization
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Legal Business Name | TRISTATE HEALTHCARE RESOURCES, LLC
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 11826 GALLIA PIKE SUITE D
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City | WHEELERSBURG
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State | OH
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Zip | 45694-9119
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Country | US
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Telephone | 740-574-8961
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Fax | 740-874-1600
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Provider Business Mailing Address
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Address Line | 11826 GALLIA PIKE SUITE D
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City | WHEELERSBURG
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State | OH
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Zip | 45694-9119
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Country | US
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Telephone | 740-574-8961
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Fax | 740-874-1600
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN HURST
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Credential |
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Telephone | 740-574-8961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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