Provider Demographics
NPI:1154692994
Name:COMFORT MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:COMFORT MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-6902
Mailing Address - Street 1:129 BETHEA RD
Mailing Address - Street 2:STE 402
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3806
Mailing Address - Country:US
Mailing Address - Phone:678-519-1474
Mailing Address - Fax:678-519-1767
Practice Address - Street 1:129 BETHEA RD
Practice Address - Street 2:STE 402
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3806
Practice Address - Country:US
Practice Address - Phone:678-519-1474
Practice Address - Fax:678-519-1767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RMH MEDICAL GROUP HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5639280001Medicare NSC