Provider Demographics
NPI:1326318361
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 1:15320 ENDEAVOR DR
Mailing Address - Street 2:UNIT 900
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4946
Mailing Address - Country:US
Mailing Address - Phone:877-204-3733
Mailing Address - Fax:
Practice Address - Street 1:15320 ENDEAVOR DRIVE
Practice Address - Street 2:UNIT 900
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-776-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RMH MEDICAL GROUP HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000586A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200855820AMedicaid
FL5639280001Medicare NSC