Healthcare Provider Details

I. General information

NPI: 1255438412
Provider Name (Legal Business Name): TRI COUNTY MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 NW 2ND AVE 220D
MIAMI GARDENS FL
33169-4063
US

IV. Provider business mailing address

18800 NW 2ND AVE 220D
MIAMI GARDENS FL
33169-4063
US

V. Phone/Fax

Practice location:
  • Phone: 305-651-0596
  • Fax: 305-651-0597
Mailing address:
  • Phone: 305-651-0596
  • Fax: 305-651-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 6401
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313132
License Number StateFL

VIII. Authorized Official

Name: MRS. SUYIMA TORRES
Title or Position: PRESIDENT
Credential:
Phone: 305-651-0596