Provider Demographics
NPI:1538330600
Name:DIABETIC SUPPLY DISTRIBUTORS
Entity Type:Organization
Organization Name:DIABETIC SUPPLY DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-369-7600
Mailing Address - Street 1:18976 SE FEARNLEY DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1622
Mailing Address - Country:US
Mailing Address - Phone:561-744-1908
Mailing Address - Fax:
Practice Address - Street 1:18976 SE FEARNLEY DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-1622
Practice Address - Country:US
Practice Address - Phone:561-744-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies