Provider Demographics
NPI:1669892923
Name:TRICARE MEDICAL &HEALTH SUPPLIES, LLC
Entity type:Organization
Organization Name:TRICARE MEDICAL &HEALTH SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS ASUQUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-333-0564
Mailing Address - Street 1:505 HAMPTON PARK BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 HAMPTON PARK BLVD STE H
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3862
Practice Address - Country:US
Practice Address - Phone:301-333-0564
Practice Address - Fax:301-333-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies