Provider Demographics
NPI:1376776724
Name:DIABETIC HEALTHLINK, LLC
Entity Type:Organization
Organization Name:DIABETIC HEALTHLINK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-405-7853
Mailing Address - Street 1:1410 WHITE DR
Mailing Address - Street 2:STE D
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-9657
Mailing Address - Country:US
Mailing Address - Phone:855-405-7853
Mailing Address - Fax:877-544-2162
Practice Address - Street 1:1410 WHITE DR
Practice Address - Street 2:STE D
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-9657
Practice Address - Country:US
Practice Address - Phone:855-405-7853
Practice Address - Fax:877-544-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6602530001Medicare NSC