Provider Demographics
NPI:1891078309
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:
Practice Address - Street 1:2115 CHAPMAN RD
Practice Address - Street 2:STE 135
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1618
Practice Address - Country:US
Practice Address - Phone:423-893-6163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RMH MEDICAL GROUP HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001052332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4582489Medicaid
TN5639280002Medicare NSC
TN4582489Medicaid