Provider Demographics
NPI:1760460182
Name:TRI-STATE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:TRI-STATE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-579-2899
Mailing Address - Street 1:2375 E MAIN ST
Mailing Address - Street 2:SUITE A-106
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1434
Mailing Address - Country:US
Mailing Address - Phone:864-579-2899
Mailing Address - Fax:864-579-2844
Practice Address - Street 1:2375 E MAIN ST
Practice Address - Street 2:SUITE A-106
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1434
Practice Address - Country:US
Practice Address - Phone:864-579-2899
Practice Address - Fax:864-579-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC042 50518 2332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2662Medicaid
SC5523630001Medicare ID - Type Unspecified