Triad Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

06771/11.1 Issued in MS

Legal business name

TRIAD MEDICAL SUPPLY LLC

Practice address

360 Winkler Dr Ste F
Alpharetta, GA 30004-0764

Phone

(601) 605-1699

Fax

(800) 511-1137

NPI assigned

Dec 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rollyne Klem, RN, CRNI, OCN

Title

President/Ceo

Phone

(678) 762-1520

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• dba INFU-CARE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394668800000",
    "number": "1669532602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 WINKLER DR STE F",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300040764",
            "telephone_number": "601-605-1699",
            "fax_number": "800-511-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 WINKLER DR STE F",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300040764",
            "telephone_number": "601-605-1699",
            "fax_number": "800-511-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2014-03-13",
        "status": "A",
        "authorized_official_last_name": "KLEM",
        "authorized_official_first_name": "ROLLYNE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "678-762-1520",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, CRNI, OCN"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "06771-11.1",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "06771/11.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07806820",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACM",
            "identifier": "1030137",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS",
            "identifier": "611626100",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba INFU-CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.