Healthcare Provider Details

I. General information

NPI: 1639161177
Provider Name (Legal Business Name): TRI-CITY HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3878 HIGHWAY 4
JAY FL
32565-1753
US

IV. Provider business mailing address

3878 HIGHWAY 4
JAY FL
32565-1753
US

V. Phone/Fax

Practice location:
  • Phone: 850-675-1221
  • Fax: 850-675-1270
Mailing address:
  • Phone: 850-675-1221
  • Fax: 850-675-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1312572
License Number StateFL

VIII. Authorized Official

Name: OBIE DERREK NEVELS
Title or Position: OWNER
Credential:
Phone: 850-675-1221