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General NPI Number Information
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NPI Number | 1427080258
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Entity Type | Organization
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Legal Business Name | TRINITY VALLEY MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 416 S PALESTINE ST SUITE G
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City | ATHENS
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State | TX
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Zip | 75751-2537
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Country | US
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Telephone | 903-681-0898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1627
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City | ATHENS
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State | TX
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Zip | 75751-1627
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Country | US
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Telephone | 903-681-0898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE RACKLEY
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Credential |
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Telephone | 903-681-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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