Provider Demographics
NPI:1326232463
Name:PEACE OF MIND MEDICAL SUPPLY
Entity type:Organization
Organization Name:PEACE OF MIND MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CROAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-522-5774
Mailing Address - Street 1:PO BOX 302493
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-0021
Mailing Address - Country:US
Mailing Address - Phone:617-522-5774
Mailing Address - Fax:617-524-3132
Practice Address - Street 1:86 SOUTH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3143
Practice Address - Country:US
Practice Address - Phone:617-522-5774
Practice Address - Fax:617-524-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies