Provider Demographics
NPI:1316046014
Name:PELOTON HEALTHCARE SUPPLY
Entity Type:Organization
Organization Name:PELOTON HEALTHCARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EZEKIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-469-1549
Mailing Address - Street 1:312 NATCHEZ CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3420
Mailing Address - Country:US
Mailing Address - Phone:615-469-1549
Mailing Address - Fax:615-469-4445
Practice Address - Street 1:312 NATCHEZ CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3420
Practice Address - Country:US
Practice Address - Phone:615-469-1549
Practice Address - Fax:615-469-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies