Provider Demographics
NPI:1003900630
Name:TRI-STATE HOME RESPIRATORY CARE
Entity Type:Organization
Organization Name:TRI-STATE HOME RESPIRATORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-1030
Mailing Address - Street 1:2620 SUMMERHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3956
Mailing Address - Country:US
Mailing Address - Phone:903-792-1030
Mailing Address - Fax:903-793-2266
Practice Address - Street 1:2620 SUMMERHILL ROAD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3956
Practice Address - Country:US
Practice Address - Phone:903-792-1030
Practice Address - Fax:903-793-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0008225332B00000X
TX0040664332BX2000X
ARMG00341332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR87885OtherAR BLUECROSSBLUE SHIELD
TX530609OtherTX BLUE CROSSBLUE SHIELD
TX1257950001Medicare ID - Type UnspecifiedMEDICARE REGION C