Provider Demographics
NPI:1679560999
Name:AMERICAN DIABETIC SUPPLY, INC.
Entity Type:Organization
Organization Name:AMERICAN DIABETIC SUPPLY, INC.
Other - Org Name:AMERICAN MEDCARE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-677-1002
Mailing Address - Street 1:400 S ATLANTIC AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-7146
Mailing Address - Country:US
Mailing Address - Phone:386-677-1002
Mailing Address - Fax:386-673-9421
Practice Address - Street 1:400 S ATLANTIC AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-7146
Practice Address - Country:US
Practice Address - Phone:386-677-1002
Practice Address - Fax:386-673-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132357741Medicaid
IN200166480AMedicaid
GA00768974AMedicaid
LA1689645Medicaid
ME183900000Medicaid
KS100297590AMedicaid
MD74200500Medicaid
NM000S7538Medicaid
ID804289900Medicaid
TX010477001Medicaid
AL009705310Medicaid
AR132357741Medicaid
AR132357741Medicaid
MD74200500Medicaid
NC7702033Medicaid
1064280001Medicare ID - Type UnspecifiedPROVIDER NUMBER
GA00768974AMedicaid
ID804289900Medicaid
AR132357741Medicaid
KY90622291Medicaid