Provider Demographics
NPI:1841201373
Name:TRINITY HOME CARE MEDICAL SUPPLIES
Entity type:Organization
Organization Name:TRINITY HOME CARE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KUTTIPARAMBIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-289-7600
Mailing Address - Street 1:617 W KEARNEY ST
Mailing Address - Street 2:301
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8816
Mailing Address - Country:US
Mailing Address - Phone:972-289-7600
Mailing Address - Fax:972-289-1002
Practice Address - Street 1:617 W KEARNEY ST
Practice Address - Street 2:301
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-8816
Practice Address - Country:US
Practice Address - Phone:972-289-7600
Practice Address - Fax:972-289-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083391332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841201373Medicaid
TX5662210001Medicare ID - Type Unspecified