Provider Demographics
NPI:1952311557
Name:THE DIABETIC & MOBILITY STORE, INC.
Entity Type:Organization
Organization Name:THE DIABETIC & MOBILITY STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-361-0103
Mailing Address - Street 1:PO BOX 3517
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34692-0517
Mailing Address - Country:US
Mailing Address - Phone:727-361-0103
Mailing Address - Fax:727-937-7389
Practice Address - Street 1:CARR 111 KM 14.3
Practice Address - Street 2:BO HATO ARRIBA #5
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-0039
Practice Address - Fax:787-280-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
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
PR4892140001Medicare NSC