Provider Demographics
NPI:1407137284
Name:PALM BEACH DIABETIC SUPPLY, INC.
Entity Type:Organization
Organization Name:PALM BEACH DIABETIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-586-5460
Mailing Address - Street 1:814 W LANTANA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1553
Mailing Address - Country:US
Mailing Address - Phone:561-586-5460
Mailing Address - Fax:561-586-5458
Practice Address - Street 1:814 W LANTANA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1553
Practice Address - Country:US
Practice Address - Phone:561-586-5460
Practice Address - Fax:561-586-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6599100001Medicare NSC