Provider Demographics
NPI:1598862245
Name:DIABETIC SUPPLY FOUNDATION OF FT MYERS
Entity Type:Organization
Organization Name:DIABETIC SUPPLY FOUNDATION OF FT MYERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-238-8944
Mailing Address - Street 1:205 JOEL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-0201
Mailing Address - Country:US
Mailing Address - Phone:239-848-6696
Mailing Address - Fax:
Practice Address - Street 1:205 JOEL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-0201
Practice Address - Country:US
Practice Address - Phone:239-848-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL032752332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0886420001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER