Provider Demographics
NPI:1831290600
Name:DIABETIC SUPPLIES OF AMERICA, INC.
Entity Type:Organization
Organization Name:DIABETIC SUPPLIES OF AMERICA, INC.
Other - Org Name:DIABETIC SUPPLIES NOF THE PALM BEACHES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-840-1043
Mailing Address - Street 1:924 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2404
Mailing Address - Country:US
Mailing Address - Phone:800-555-2561
Mailing Address - Fax:561-840-1042
Practice Address - Street 1:924 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2404
Practice Address - Country:US
Practice Address - Phone:800-555-2561
Practice Address - Fax:561-840-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8243OtherBCBS- DME DIABETIC SUPPLI
FL0938010001Medicare ID - Type UnspecifiedDME-DIABETIC SUPPLIES ONL