Provider Demographics
NPI:1275011652
Name:TRI-STATE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:TRI-STATE MEDICAL SUPPLIES, LLC
Other - Org Name:TRI-STATE MEDICAL SUPPLIES NORTH GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-579-2899
Mailing Address - Street 1:2375 E MAIN ST STE A106
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1411
Mailing Address - Country:US
Mailing Address - Phone:864-579-2899
Mailing Address - Fax:864-579-2844
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 2900
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-586-5740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-STATE MEDICAL SUPPLIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760460182Medicaid