MEDICARE: TRI-CARE 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
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHRE008101	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2019710	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720160666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-0159
Country	:	US
Telephone Number	:	912-557-4701
Fax Number	:	912-557-6078

Provider Business Practice Location Address
First Line	:	214 S MAIN ST
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-4602
Country	:	US
Telephone Number	:	912-557-4701
Fax Number	:	912-557-6078

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK TOOLE
Credential	:	RPH
Telephone Number	:	912-557-4701

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/19/2016

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Directions to “TRI-CARE INC ” Practice Location

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