Provider Demographics
NPI:1326744137
Name:TRITON SUPPLY
Entity type:Organization
Organization Name:TRITON SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-514-5646
Mailing Address - Street 1:PO BOX 4682
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-4682
Mailing Address - Country:US
Mailing Address - Phone:800-599-8553
Mailing Address - Fax:435-774-1919
Practice Address - Street 1:3831 E BLUE LUPINE DR STE B2
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8461
Practice Address - Country:US
Practice Address - Phone:907-561-9220
Practice Address - Fax:907-561-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies