Provider Demographics
NPI:1407887102
Name:TRISTATE HOME MEDICAL, L.L.C.
Entity Type:Organization
Organization Name:TRISTATE HOME MEDICAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-777-0757
Mailing Address - Street 1:50 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3013
Mailing Address - Country:US
Mailing Address - Phone:301-777-0757
Mailing Address - Fax:301-777-7741
Practice Address - Street 1:50 PERSHING ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3013
Practice Address - Country:US
Practice Address - Phone:301-777-0757
Practice Address - Fax:301-777-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01164156332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies