Provider Demographics
NPI:1619978475
Name:AMERICAN DIABETES SERVICES INC
Entity Type:Organization
Organization Name:AMERICAN DIABETES SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-245-9264
Mailing Address - Street 1:6560 W ROGERS CIR
Mailing Address - Street 2:STE 19
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2746
Mailing Address - Country:US
Mailing Address - Phone:561-245-9264
Mailing Address - Fax:561-886-2775
Practice Address - Street 1:6560 W ROGERS CIR
Practice Address - Street 2:STE 19
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2746
Practice Address - Country:US
Practice Address - Phone:561-245-9264
Practice Address - Fax:561-886-2775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADS MEDICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-02
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2004-08352332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1190940001Medicare NSC