Provider Demographics
NPI:1265479018
Name:CERTIFIED DIABETIC & MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:CERTIFIED DIABETIC & MEDICAL SERVICES, INC
Other - Org Name:CERTIFIED DIABETIC & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-459-3882
Mailing Address - Street 1:190 FORTENBERRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3401
Mailing Address - Country:US
Mailing Address - Phone:321-459-3882
Mailing Address - Fax:321-454-4614
Practice Address - Street 1:190 FORTENBERRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3401
Practice Address - Country:US
Practice Address - Phone:321-459-3882
Practice Address - Fax:321-454-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5479530001Medicare NSC