# MYSTAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841112927
- **Authorized official:** RENATO NAMOC (OWNER)
- **Authorized official phone:** (406) 309-6462

## Contact information

- **Practice address:** 145 PINE HAVEN SHORES RD STE 1000A, SHELBURNE, VT 05482-7812
- **Practice address phone:** (406) 309-6462
- **Mailing address:** 145 PINE HAVEN SHORES RD STE 1000A, SHELBURNE, VT 05482-7812
- **Mailing address phone:** (406) 309-6462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2026
- **Last updated:** 07/29/2026