Provider Demographics
NPI:1972857639
Name:TRI-COUNTY HOME MEDICAL EQUIPMENT & REPAIRS LLC
Entity Type:Organization
Organization Name:TRI-COUNTY HOME MEDICAL EQUIPMENT & REPAIRS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-253-9850
Mailing Address - Street 1:408 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1812
Mailing Address - Country:US
Mailing Address - Phone:906-253-9850
Mailing Address - Fax:906-253-9855
Practice Address - Street 1:408 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1812
Practice Address - Country:US
Practice Address - Phone:906-253-9850
Practice Address - Fax:906-253-9855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6746100001Medicare NSC