Provider Demographics
NPI:1225099484
Name:AMERICAN DIABETIC SUPPLY SYSTEMS INC
Entity Type:Organization
Organization Name:AMERICAN DIABETIC SUPPLY SYSTEMS INC
Other - Org Name:DIABETIC SUPPLIES DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-794-6999
Mailing Address - Street 1:5202 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2535
Mailing Address - Country:US
Mailing Address - Phone:910-794-6999
Mailing Address - Fax:910-794-9066
Practice Address - Street 1:5202 CAROLINA BEACH RD
Practice Address - Street 2:SUITE 15
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2535
Practice Address - Country:US
Practice Address - Phone:910-794-6999
Practice Address - Fax:910-794-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000513332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045KUOtherBLUE CROSS ID NUMBER
NC7703190Medicaid
NC1321850001Medicare ID - Type Unspecified