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NPI Code Detail

MEDICARE: TRICARE MEDICAL SUPPLIES, INC.

MEDICARE: TRICARE MEDICAL SUPPLIES, 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1336630508
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRICARE MEDICAL SUPPLIES, INC.
Provider Business Mailing Address
First Line : 104 GLEN OAK BLVD STE 120
Second Line :
City : HENDERSONVILLE
State : TN
Zip : 37075-6421
Country : US
Telephone Number : 615-991-5970
Fax Number : 615-991-5982
Provider Business Practice Location Address
First Line : 104 GLEN OAK BLVD STE 120
Second Line :
City : HENDERSONVILLE
State : TN
Zip : 37075-6421
Country : US
Telephone Number : 615-991-5970
Fax Number : 615-991-5982
Authorized Official
Title or Position : PRESIDENT/CEO
Name : ANSARI M KASSIM
Credential :
Telephone Number : 615-230-3000
Provider Enumeration Date : 05/23/2018
Last Update Date : 05/23/2018

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