Provider Demographics
NPI:1801217815
Name:T C MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:T C MEDICAL SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSALESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-246-9499
Mailing Address - Street 1:555 E NORTH LN STE 5075
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 W NEWBERRY RD
Practice Address - Street 2:STE E7
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-260-0844
Practice Address - Fax:888-506-6623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROCARE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-17
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012813600Medicaid
FL012813600Medicaid