Provider Demographics
NPI:1770830309
Name:ADVANCED DIABETIC SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED DIABETIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SANTULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-1190
Mailing Address - Street 1:6425 PENSACOLA BLVD
Mailing Address - Street 2:BUILDING 2 SUITE 5
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1701
Mailing Address - Country:US
Mailing Address - Phone:770-339-1190
Mailing Address - Fax:770-339-1192
Practice Address - Street 1:6425 PENSACOLA BLVD
Practice Address - Street 2:BUILDING 2 SUITE 5
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-1701
Practice Address - Country:US
Practice Address - Phone:770-339-1190
Practice Address - Fax:770-339-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies