Provider Demographics
NPI:1134323306
Name:PEACE OF MIND MEDICAL SUPPLY CO LLC
Entity Type:Organization
Organization Name:PEACE OF MIND MEDICAL SUPPLY CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCKEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-743-3179
Mailing Address - Street 1:7112 E CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9432
Mailing Address - Country:US
Mailing Address - Phone:800-734-3179
Mailing Address - Fax:800-367-6163
Practice Address - Street 1:7112 E CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9432
Practice Address - Country:US
Practice Address - Phone:800-743-3179
Practice Address - Fax:800-367-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5934670002Medicare NSC