Provider Demographics
NPI:1528188091
Name:TRI MED MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:TRI MED MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MYRIE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:215-836-4828
Mailing Address - Street 1:4110 BUTLER PIKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1547
Mailing Address - Country:US
Mailing Address - Phone:215-836-4828
Mailing Address - Fax:215-836-4830
Practice Address - Street 1:4110 BUTLER PIKE
Practice Address - Street 2:SUITE 106
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1547
Practice Address - Country:US
Practice Address - Phone:215-836-4828
Practice Address - Fax:215-836-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA80939233332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01972943Medicaid
PA01972943Medicaid