Provider Demographics
NPI:1447883673
Name:TRIAD MOBILITY & SUPPLY LLC
Entity type:Organization
Organization Name:TRIAD MOBILITY & SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSGEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-531-1550
Mailing Address - Street 1:121 WALNUT CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9337
Mailing Address - Country:US
Mailing Address - Phone:469-531-1550
Mailing Address - Fax:
Practice Address - Street 1:2378 CORPORATION PKWY STE D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6749
Practice Address - Country:US
Practice Address - Phone:336-609-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies