Provider Demographics
NPI:1679576557
Name:TRI-COUNTY MEDICAL SUPPLY & RESPIRATORY SERVICES, INC.
Entity type:Organization
Organization Name:TRI-COUNTY MEDICAL SUPPLY & RESPIRATORY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-238-7085
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0760
Mailing Address - Country:US
Mailing Address - Phone:870-895-5022
Mailing Address - Fax:870-895-4759
Practice Address - Street 1:260 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-9545
Practice Address - Country:US
Practice Address - Phone:870-895-5022
Practice Address - Fax:870-895-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137760716Medicaid
ARBCBS PROVIDER NUMOther49603
ARBCBS PROVIDER NUMOther49603