Provider Demographics
NPI:1821610122
Name:CGM DIABETIC SUPPLY
Entity Type:Organization
Organization Name:CGM DIABETIC SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAYLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-570-5915
Mailing Address - Street 1:1271 SW 13TH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5364
Mailing Address - Country:US
Mailing Address - Phone:561-299-6893
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 210-49
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5187
Practice Address - Country:US
Practice Address - Phone:561-570-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies