Provider Demographics
NPI:1114283413
Name:COMFORT MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:COMFORT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-6902
Mailing Address - Street 1:615 S YONGE ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7541
Mailing Address - Country:US
Mailing Address - Phone:386-673-6902
Mailing Address - Fax:386-673-6976
Practice Address - Street 1:20 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2161
Practice Address - Country:US
Practice Address - Phone:877-204-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RMH MEDICAL GROUP HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5639280001Medicare NSC