Provider Demographics
NPI:1144595679
Name:TRIAD MEDICAL ALLIANCE
Entity Type:Organization
Organization Name:TRIAD MEDICAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-244-4811
Mailing Address - Street 1:3790 OLD US HIGHWAY 41 N STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6867
Mailing Address - Country:US
Mailing Address - Phone:229-241-8811
Mailing Address - Fax:
Practice Address - Street 1:3790 OLD US HIGHWAY 41 N STE C
Practice Address - Street 2:SUITE C
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6867
Practice Address - Country:US
Practice Address - Phone:229-241-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO-007058332B00000X, 332BC3200X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies