Basic Information
| Provider Information | |||||||||
| NPI: | 1134120074 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRICOUNTY MEDICAL EQUIPMENT AND SUPPLY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MILLER MEDICAL EQUIPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W GERMANTOWN PIKE STE 250 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106306357 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2929 ARCH ST | ||||||||
| Address2: | STE 1740, CIRA CENTRE | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191042857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157392238 | ||||||||
| FaxNumber: | 2157391124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 100793630 | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332BP3500X | 1000003158 | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | 600005028 | PA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1019538 | 01 | PA | KEYSTONE MERCY | OTHER | 1020539910006 | 05 | PA | MEDICAID | 11912 | 01 | PA | HEALTH PARTNERS | OTHER | 213948 | 01 | PA | IBC PERSONAL CHOICE | OTHER | 0164346201 | 01 | PA | AMERICHOICE | OTHER | 0099444 | 01 | PA | AETNA | OTHER | 0141992 | 05 | NJ | MEDICAID | 0002511000 | 01 | PA | KEYSTONE HEALTH PLAN EAS | OTHER |