Provider Demographics
NPI:1508931346
Name:TDA, INC
Entity Type:Organization
Organization Name:TDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-668-0302
Mailing Address - Street 1:295 COUNTY ROAD 728
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-9315
Mailing Address - Country:US
Mailing Address - Phone:205-668-0302
Mailing Address - Fax:205-668-2622
Practice Address - Street 1:295 COUNTY ROAD 728
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-9315
Practice Address - Country:US
Practice Address - Phone:205-668-0302
Practice Address - Fax:205-668-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1062360001Medicare NSC