Provider Demographics
NPI:1043579881
Name:TRITON DURABLE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:TRITON DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-323-5474
Mailing Address - Street 1:2806 JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3703
Mailing Address - Country:US
Mailing Address - Phone:469-323-5474
Mailing Address - Fax:
Practice Address - Street 1:305 S JUPITER RD
Practice Address - Street 2:#12
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3050
Practice Address - Country:US
Practice Address - Phone:469-323-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies