MEDICARE: PEACH MEDICAL LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871753442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACH MEDICAL LLC

Provider Business Mailing Address
First Line	:	501 W 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-4758
Country	:	US
Telephone Number	:	317-577-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 PENNSYLVANIA PKWY
Second Line	:	#200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2301
Country	:	US
Telephone Number	:	317-577-8892
Fax Number	:	317-577-8892

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. CLYDE E PEACH JR.
Credential	:	C.O.
Telephone Number	:	317-445-1475

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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Directions to “PEACH MEDICAL LLC ” Practice Location

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