Provider Demographics
NPI:1336577857
Name:TRI STATE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:TRI STATE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YUNGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-337-2399
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-0251
Mailing Address - Country:US
Mailing Address - Phone:419-337-2399
Mailing Address - Fax:419-337-5392
Practice Address - Street 1:1255 N SCOTT ST STE 340
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1060
Practice Address - Country:US
Practice Address - Phone:419-599-2273
Practice Address - Fax:419-599-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies