Provider Demographics
NPI:1558635854
Name:TRIPLE ALLIANCE, INC.
Entity Type:Organization
Organization Name:TRIPLE ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:202-525-2066
Mailing Address - Street 1:1217 BRENTWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1019
Mailing Address - Country:US
Mailing Address - Phone:202-526-2066
Mailing Address - Fax:
Practice Address - Street 1:1217 BRENTWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1019
Practice Address - Country:US
Practice Address - Phone:202-526-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC350000082138332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6716290001Medicare NSC
MD6716290001Medicare NSC