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Organization
VERNON INTEGRATIVE MEDICAL GROUP LLC
Active
Organization
VERNON INTEGRATIVE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON TRISTER M.D. (MD INTERNAL MEDICINE)
(508) 754-9950
Entity
Organization
Contact information
Practice address
10 WINTHROP ST, WORCESTER, MA 01604
(508) 754-9950
(508) 754-2592
Mailing address
10 WINTHROP ST, WORCESTER, MA 01604
(508) 754-9950
(508) 754-2592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
80587
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400053
UNITED HEALTH CARE
—
01
—
0400664
EVERCARE
—
01
—
080587
TUFTS
—
05
—
110082379A
—
MA
01
—
1928586
CIGNA
—
01
—
29736
FALLON
—
05
—
3144941
—
MA
01
—
33586
HEALTH NEW ENGLAND
—
01
—
43899
BMCHP
MA
01
—
5841132
AETNA
MA
01
—
6141990001
NATIONAL SUPPLIER CLEARINGHOUSE
MA
01
—
66212
HARVARD PILGRIM
—
01
—
985162
NETWORK HEALTH
—
01
—
J16290
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/09/2008
Last updated
09/20/2012
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