EZ DIABETIC SUPPLIES, INC.

Provider Demographics

• NPI: 1689677023
• Name: EZ DIABETIC SUPPLIES, INC.
• Entity Type: Organization
• Organization Name: EZ DIABETIC SUPPLIES, INC.
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MR
• Authorized Official - First Name: ELLIOT
• Authorized Official - Middle Name: M
• Authorized Official - Last Name: ZIMMERMAN
• Authorized Official - Phone: 207-386-1080
• Mailing Address - Street 1: 61 STATE RD
• Mailing Address - City: WEST BATH
• Mailing Address - State: ME
• Mailing Address - Zip Code: 04530-6301
• Mailing Address - Country: US
• Mailing Address - Phone: 207-386-1080
• Mailing Address - Fax: 207-386-1088
• Practice Address - Street 1: 61 STATE RD
• Practice Address - City: WEST BATH
• Practice Address - State: ME
• Practice Address - Zip Code: 04530-6301
• Practice Address - Country: US
• Practice Address - Phone: 207-386-1080
• Practice Address - Fax: 207-386-1088
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-05-31
• Last Update Date: 2012-04-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	100249992-00	Medicaid
OH	2428733	Medicaid
NH	30762818	Medicaid
KY	90013939	Medicaid
LA	1344494	Medicaid
WV	3810004618	Medicaid
ME	155450000	Medicaid
MI	1689677023	Medicaid
IL	ZERO43692703001	Medicaid
ME	047029	Other	ANTHEM BCBS
IN	200916420 A	Medicaid
NY	ZERO3161800	Medicaid
AL	009975265	Medicaid
VA	010369258	Medicaid
VT	1017916	Medicaid
AR	159235741	Medicaid
MN	1689677023	Medicaid
SC	DM1153	Medicaid
MS	06559353	Medicaid
CA	1689677023	Medicaid
UT	1689677023	Medicaid
TN	4582522	Medicaid
PA	7783934	Medicaid
PA	7783934	Medicaid