Organization
PENINSULA BIOMEDICAL, INC.
Active
Other names
Peninsula Medical, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA CRISWELL (INSURANCE BILLING MANAGER)
(831) 430-9066
Entity
Organization
Contact information
Practice address
15 CAMP EVERS LN, SCOTTS VALLEY, CA 95066-4128
(831) 430-9066
(831) 430-9068
Mailing address
15 CAMP EVERS LN, SCOTTS VALLEY, CA 95066-4128
(831) 430-9066
(831) 430-9068
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
1196930001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107491
—
OH
05
—
29401372
—
CO
05
—
4549517
—
MI
05
—
82712600
—
WI
05
—
9048612
—
WA
05
—
9102475
—
VA
Enumeration date
10/27/2006
Last updated
08/22/2020
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