Provider Demographics
NPI:1639161177
Name:TRI-CITY HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:TRI-CITY HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBIE
Authorized Official - Middle Name:DERREK
Authorized Official - Last Name:NEVELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-675-1221
Mailing Address - Street 1:3878 HIGHWAY 4
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1753
Mailing Address - Country:US
Mailing Address - Phone:850-675-1221
Mailing Address - Fax:850-675-1270
Practice Address - Street 1:3878 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1753
Practice Address - Country:US
Practice Address - Phone:850-675-1221
Practice Address - Fax:850-675-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312572332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5421190001Medicare NSC