Healthcare Provider Details

I. General information

NPI: 1114283413
Provider Name (Legal Business Name): COMFORT MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GRAND AVE STE D
GREENVILLE SC
29607-2161
US

IV. Provider business mailing address

615 S YONGE ST
ORMOND BEACH FL
32174-7541
US

V. Phone/Fax

Practice location:
  • Phone: 877-204-3733
  • Fax:
Mailing address:
  • Phone: 386-673-6902
  • Fax: 386-673-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: CRAIG A DALEY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 386-673-6902