Provider Demographics
NPI:1336468313
Name:DIABETIC MEDICAL CONCEPTS, INC.
Entity Type:Organization
Organization Name:DIABETIC MEDICAL CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-287-6133
Mailing Address - Street 1:102 FERNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7363
Mailing Address - Country:US
Mailing Address - Phone:904-287-6133
Mailing Address - Fax:866-247-0528
Practice Address - Street 1:102 FERNBROOK DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7363
Practice Address - Country:US
Practice Address - Phone:904-287-6133
Practice Address - Fax:866-247-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-29
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies