Organization
PENINSULA BIOMEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY REID (PRESIDENT/OWNER)
(831) 430-9066
Entity
Organization
Contact information
Practice address
500-01 WAIT AVE, WAKE FOREST, NC 27587
(919) 556-8934
(919) 556-0693
Mailing address
PO BOX 66149, 108 WHISPERING PINES DR SUITE 115, SCOTTS VALLEY, CA 95066
(831) 430-9066
(831) 430-9068
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00508
NC
332BC3200X
Customized Equipment (DME)
00508
NC
335E00000X
Prosthetic/Orthotic Supplier
00508
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010107199
—
VA
01
—
0428V
BCBS NC
NC
05
—
9001254300
—
KY
Enumeration date
08/09/2006
Last updated
09/20/2017
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