Provider Demographics
NPI:1336203819
Name:TRI-STATE MEDICAL HOME HEALTH
Entity Type:Organization
Organization Name:TRI-STATE MEDICAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-250-1996
Mailing Address - Street 1:615 DELAWARE AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2827
Mailing Address - Country:US
Mailing Address - Phone:601-250-1996
Mailing Address - Fax:601-250-1997
Practice Address - Street 1:612 DELAWARE AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4000
Practice Address - Country:US
Practice Address - Phone:601-250-1996
Practice Address - Fax:601-250-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1214480002Medicare NSC