| Name: | Tristate Medical Supply, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Feb 2007 (18 years ago) |
| Entity Number: | 000-490-988 |
| Register Number: | 000490988 |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 2253 THIRD AVE, STE 1DOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
Activities
SELL MEDICAL SUPPLIES/EQUIPMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407908437 | 2007-01-18 | 2020-09-02 | 2253 THIRD AVE STE 1, DOTHAN, AL, 363015303, US | 2253 THIRD AVE STE 1, DOTHAN, AL, 363015303, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-886-9111 |
| Fax | 3348869255 |
| Fax | 3343237303 |
Authorized person
| Name | DEBRA CASEY |
| Role | OFFICE MANAGER |
| Phone | 3348869111 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 786 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106600 |
| State | AL |
| Name | Role |
|---|---|
| EUBANKS, JAMES ANTHONY JR | Member |
| EUBANKS, CAROL | Member |
| Name | Role |
|---|---|
| EUBANKS, JAMES ANT | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
