MEDICARE: PEACH MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1164760203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACH MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	301 STIMSON LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8098
Country	:	US
Telephone Number	:	803-404-4233
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 STIMSON LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8098
Country	:	US
Telephone Number	:	803-404-4233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SALENA DENISE WILLIAMS
Credential	:
Telephone Number	:	803-404-4233

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	01/24/2013

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