Provider Demographics
NPI:1588853170
Name:DESTINY MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:DESTINY MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-564-3494
Mailing Address - Street 1:12200 E ILIFF AVE
Mailing Address - Street 2:SUITE C-202
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1251
Mailing Address - Country:US
Mailing Address - Phone:866-564-3494
Mailing Address - Fax:866-564-3424
Practice Address - Street 1:12200 E ILIFF AVE
Practice Address - Street 2:SUITE C-202
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1251
Practice Address - Country:US
Practice Address - Phone:866-564-3494
Practice Address - Fax:866-564-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6044410001Medicare NSC