Provider Demographics
NPI:1619329455
Name:TRICARE MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:TRICARE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-454-3591
Mailing Address - Street 1:4928 EDMONDSON PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4787
Mailing Address - Country:US
Mailing Address - Phone:615-454-3591
Mailing Address - Fax:615-454-3824
Practice Address - Street 1:4928 EDMONDSON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4787
Practice Address - Country:US
Practice Address - Phone:615-454-3591
Practice Address - Fax:615-454-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies