Provider Demographics
NPI:1407966153
Name:QUALITY DIABETES SUPPLIES, INC.
Entity Type:Organization
Organization Name:QUALITY DIABETES SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FREDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-942-0114
Mailing Address - Street 1:438 CARR AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6147
Mailing Address - Country:US
Mailing Address - Phone:205-942-0114
Mailing Address - Fax:295-942-6472
Practice Address - Street 1:438 CARR AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6147
Practice Address - Country:US
Practice Address - Phone:205-942-0114
Practice Address - Fax:295-942-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL485332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703878Medicaid
NC7703878Medicaid