Provider Demographics
NPI:1003532425
Name:DIABETIC MEDICS LLC
Entity type:Organization
Organization Name:DIABETIC MEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-423-2525
Mailing Address - Street 1:26039 205TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50063-8254
Mailing Address - Country:US
Mailing Address - Phone:515-669-9845
Mailing Address - Fax:
Practice Address - Street 1:26039 205TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-8254
Practice Address - Country:US
Practice Address - Phone:515-669-9845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies