Peacock Medical Equipment and Home Health Care LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PEACOCK MEDICAL EQUIPMENT AND HOME HEALTH CARE LLC

Practice address

1201 Highway 19 E Bypass Suite 3
Elizabethton, TN 37643

Phone

(423) 547-3224

Fax

(180) 041-9156

NPI assigned

Jun 5, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Adam Douglas Wellington, PH.D

Title

Ceo/President

Phone

(423) 547-3224

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Peachtree Medical of Tennessee Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280880000000",
    "number": "1144456047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 19 E BYPASS SUITE 3",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "37643",
            "telephone_number": "423-547-3224",
            "fax_number": "180-041-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 19 E BYPASS SUITE 3",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "37643",
            "telephone_number": "423-547-3224",
            "fax_number": "180-041-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK MEDICAL EQUIPMENT AND HOME HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-05",
        "last_updated": "2010-08-04",
        "status": "A",
        "authorized_official_last_name": "WELLINGTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "423-547-3224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DM1334",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN BOARD FOR LICENSING HEALTHCARE FACILITIES DEPT OF HEALTH",
            "identifier": "0000001020",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514122",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144456047",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Medical of Tennessee",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kimberly Owens, FNP-C
• Sierra Faith Owens, DPT
• Kevin D Oxendine, PHARMD
• Sheryl D Pack, MD
• Teresa L Payne, NP
• Amber Lynne Pearce, DMD
• Judith Lynn Pesch, LCSW
• Alison Peters, RN
• Rachel Lynne Peters, DPT
• Physical Therapy Services, P.a.

• Durable Medical Equipment & Medical Supplies in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Durable Medical Equipment & Medical Supplies in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.