Provider Demographics
NPI:1134120074
Name:TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC
Entity Type:Organization
Organization Name:TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC
Other - Org Name:MILLER MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:610-630-6357
Mailing Address - Fax:
Practice Address - Street 1:2929 ARCH ST
Practice Address - Street 2:STE 1740, CIRA CENTRE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2857
Practice Address - Country:US
Practice Address - Phone:215-739-2238
Practice Address - Fax:215-739-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA600005028332B00000X
PA1000003158332BP3500X
PA100793630332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019538OtherKEYSTONE MERCY
PA1020539910006Medicaid
PA11912OtherHEALTH PARTNERS
PA213948OtherIBC PERSONAL CHOICE
PA0164346201OtherAMERICHOICE
PA0099444OtherAETNA
NJ0141992Medicaid
PA0002511000OtherKEYSTONE HEALTH PLAN EAS
PA11912OtherHEALTH PARTNERS
PA11912OtherHEALTH PARTNERS
PA0202990001Medicare NSC