MEDICARE: PEACE ON EARTH FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1306316443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE ON EARTH FOUNDATION INC

Provider Business Mailing Address
First Line	:	1015 ELDORADO AVE
Second Line	:
City	:	CLEARWATER BEACH
State	:	FL
Zip	:	33767-1024
Country	:	US
Telephone Number	:	727-455-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 W BUSCH BLVD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7766
Country	:	US
Telephone Number	:	813-999-4894
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KIRIT SHAH
Credential	:	LLB, DBM
Telephone Number	:	727-455-6250

Provider Enumeration Date	:	12/02/2018
Last Update Date	:	12/02/2018

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