Provider Demographics
NPI:1437101912
Name:TRI-LAKES HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:TRI-LAKES HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:518-891-1777
Mailing Address - Street 1:60 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1760
Mailing Address - Country:US
Mailing Address - Phone:518-891-1777
Mailing Address - Fax:
Practice Address - Street 1:770 NEW YORK STATE ROUTE 37
Practice Address - Street 2:AIRPORT PLAZA SUITE 17
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-562-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955711Medicaid
NY00955711Medicaid