1134120074 NPI number — TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134120074 NPI number — TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC

Employer Identification Number (EIN):

Provider Organization Name:

TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

MILLER MEDICAL EQUIPMENT

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1134120074

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/23/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

220 W GERMANTOWN PIKE STE 250

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PLYMOUTH MEETING

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19462-1437

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-630-6357

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2929 ARCH ST

Provider Second Line Business Practice Location Address:

STE 1740, CIRA CENTRE

Provider Business Practice Location Address City Name:

PHILADELPHIA

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19104-2857

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

215-739-2238

Provider Business Practice Location Address Fax Number:

215-739-1124

Provider Enumeration Date:

08/02/2005

Authorized Official Last Name:

GRIGGS

Authorized Official First Name:

STEPHE

Authorized Official Middle Name:

Authorized Official Title or Position:

CEO

Authorized Official Telephone Number:

407-206-0040

• Taxonomy code: 332B00000X , with the licence number:  600005028 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 332BP3500X , with the licence number: 1000003158 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BX2000X , with the licence number: 100793630 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1019538 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1020539910006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 11912 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 213948 . This is a "IBC PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0164346201 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0099444 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0141992 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 0002511000 . This is a "KEYSTONE HEALTH PLAN EAS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".