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General NPI Number Information
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NPI Number | 1144456047
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Entity Type | Organization
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Legal Business Name | PEACOCK MEDICAL EQUIPMENT AND HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 1201 HIGHWAY 19 E BYPASS SUITE 3
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City | ELIZABETHTON
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State | TN
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Zip | 37643
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Country | US
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Telephone | 423-547-3224
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Fax | 180-041-9156
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Provider Business Mailing Address
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Address Line | 1201 HIGHWAY 19 E BYPASS SUITE 3
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City | ELIZABETHTON
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State | TN
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Zip | 37643
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Country | US
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Telephone | 423-547-3224
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Fax | 180-041-9156
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. ADAM DOUGLAS WELLINGTON
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Credential | PH.D
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Telephone | 423-547-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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