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General NPI Number Information
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NPI Number | 1336577857
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Entity Type | Organization
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Legal Business Name | TRI STATE MEDICAL SUPPLY
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 1255 N SCOTT ST STE 340
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City | NAPOLEON
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State | OH
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Zip | 43545-1060
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Country | US
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Telephone | 419-599-2273
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Fax | 419-599-2277
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Provider Business Mailing Address
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Address Line | PO BOX 251
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City | WAUSEON
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State | OH
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Zip | 43567-0251
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Country | US
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Telephone | 419-337-2399
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Fax | 419-337-5392
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. LEIGH ANN YUNGMANN
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Credential |
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Telephone | 419-337-2399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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