Provider Demographics
NPI:1255325924
Name:DIABETIC - DME MAILERS INC
Entity Type:Organization
Organization Name:DIABETIC - DME MAILERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-518-0966
Mailing Address - Street 1:6550 GRIFFIN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4328
Mailing Address - Country:US
Mailing Address - Phone:954-518-0966
Mailing Address - Fax:954-518-0967
Practice Address - Street 1:6550 GRIFFIN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4328
Practice Address - Country:US
Practice Address - Phone:954-518-0966
Practice Address - Fax:954-518-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5317140001Medicare NSC