Provider Demographics
NPI:1912221664
Name:PEAOCK MEDICAL EQUIPMENT & HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PEAOCK MEDICAL EQUIPMENT & HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-547-3224
Mailing Address - Street 1:1201 HIGHWAY 37 19E STE 3
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-4678
Mailing Address - Country:US
Mailing Address - Phone:423-547-3224
Mailing Address - Fax:800-419-1565
Practice Address - Street 1:550 S CHURCH ST STE 11
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3306
Practice Address - Country:US
Practice Address - Phone:864-583-7751
Practice Address - Fax:800-419-1565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACOCK MEDICAL EQUIPMENT & HOME HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM1334Medicaid