MEDICARE: TRI-COUNTY MEDICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053411173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	855 W MAPLE ST
Second Line	:	STE 120
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-6613
Fax Number	:	330-877-6618

Provider Business Practice Location Address
First Line	:	855 W MAPLE ST
Second Line	:	STE 120
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-6613
Fax Number	:	330-877-6618

Authorized Official
Title or Position	:	.PRESIDENT
Name	:	JEAN ANNE LANG
Credential	:	D.O
Telephone Number	:	300-877-6613

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	05/08/2008

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