Healthcare Provider Details

I. General information

NPI: 1972857639
Provider Name (Legal Business Name): TRI-COUNTY HOME MEDICAL EQUIPMENT & REPAIRS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MAGAZINE ST
SAULT SAINTE MARIE MI
49783-1812
US

IV. Provider business mailing address

408 MAGAZINE ST
SAULT SAINTE MARIE MI
49783-1812
US

V. Phone/Fax

Practice location:
  • Phone: 906-253-9850
  • Fax: 906-253-9855
Mailing address:
  • Phone: 906-253-9850
  • Fax: 906-253-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SCOTT ANTHONY MATHESON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 906-253-9850