Healthcare Provider Details

I. General information

NPI: 1205215209
Provider Name (Legal Business Name): TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 WASHINGTON BLVD
WILLIAMSPORT PA
17701-5220
US

IV. Provider business mailing address

122 MILL RD STE A130
PHOENIXVILLE PA
19460-1412
US

V. Phone/Fax

Practice location:
  • Phone: 610-630-6357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M GVODAS JR.
Title or Position: PRESIDENT
Credential:
Phone: 610-630-6357