Healthcare Provider Details

I. General information

NPI: 1770966863
Provider Name (Legal Business Name): TRITON SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 S KYRENE RD STE 101
TEMPE AZ
85283-5455
US

IV. Provider business mailing address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

V. Phone/Fax

Practice location:
  • Phone: 480-795-7955
  • Fax: 602-428-6841
Mailing address:
  • Phone: 480-795-7955
  • Fax: 602-428-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER PACE
Title or Position: OWNER-MANAGER
Credential:
Phone: 480-795-7955