Basic Information
| Provider Information | |||||||||
| NPI: | 1972909620 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRISTATE CENTER FOR HEALTH & WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5390 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450144124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138026551 | ||||||||
| FaxNumber: | 5138582444 | ||||||||
| Practice Location | |||||||||
| Address1: | 5390 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450144124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138026551 | ||||||||
| FaxNumber: | 5138582444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2014 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | QURESHI | ||||||||
| AuthorizedOfficialFirstName: | MAJID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5138026551 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | CL.021392750-03 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.