Provider Demographics
NPI:1053319137
Name:CERTIFIED DIABETIC SERVICES, INC.
Entity Type:Organization
Organization Name:CERTIFIED DIABETIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-430-5000
Mailing Address - Street 1:3030 HORSESHOE DR S
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6139
Mailing Address - Country:US
Mailing Address - Phone:239-430-5000
Mailing Address - Fax:239-403-7722
Practice Address - Street 1:3030 HORSESHOE DR S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6143
Practice Address - Country:US
Practice Address - Phone:239-430-5000
Practice Address - Fax:239-403-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies