Provider Demographics
NPI:1699818567
Name:DIABETIC HEALTH AGENCY INC
Entity Type:Organization
Organization Name:DIABETIC HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-745-9108
Mailing Address - Street 1:PO BOX 3329
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1005
Mailing Address - Country:US
Mailing Address - Phone:561-745-9108
Mailing Address - Fax:561-745-8428
Practice Address - Street 1:150 N US HIGHWAY 1
Practice Address - Street 2:STE22A
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2723
Practice Address - Country:US
Practice Address - Phone:561-745-9108
Practice Address - Fax:561-745-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1287290001Medicare NSC