Organization
PEACH MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLYDE E PEACH JR. C.O. (VICE PRESIDENT)
(317) 445-1475
Entity
Organization
Contact information
Practice address
201 PENNSYLVANIA PKWY, #200, INDIANAPOLIS, IN 46280-2301
(317) 577-8892
(317) 577-8892
Mailing address
501 W 62ND ST, INDIANAPOLIS, IN 46260-4758
(317) 577-8892
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200312880A
—
IN
Enumeration date
06/16/2008
Last updated
06/16/2008
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