MEDICARE: PEAOCK MEDICAL EQUIPMENT & HOME HEALTH CARE 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	:	1912221664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAOCK MEDICAL EQUIPMENT & HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1201 HIGHWAY 37 19E STE 3
Second Line	:
City	:	ELIZABETHTON
State	:	TN
Zip	:	37643-4678
Country	:	US
Telephone Number	:	423-547-3224
Fax Number	:	800-419-1565

Provider Business Practice Location Address
First Line	:	550 S CHURCH ST STE 11
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-3306
Country	:	US
Telephone Number	:	864-583-7751
Fax Number	:	800-419-1565

Authorized Official
Title or Position	:	PRESIDENT/MEMBER
Name	:	DR. ADAM D WELLINGTON
Credential	:	PH.D
Telephone Number	:	423-547-3224

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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