Provider Demographics
NPI:1942203948
Name:LUIS F GUZMAN JR
Entity Type:Organization
Organization Name:LUIS F GUZMAN JR
Other - Org Name:DIABETES EQUIPMENT & REFERRAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:641-755-4402
Mailing Address - Street 1:5112 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8747
Mailing Address - Country:US
Mailing Address - Phone:641-755-4402
Mailing Address - Fax:641-755-4491
Practice Address - Street 1:5112 KAREN DR
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-8747
Practice Address - Country:US
Practice Address - Phone:641-755-4402
Practice Address - Fax:641-755-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA139005884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5705540001Medicare NSC