Provider Demographics
NPI:1184763831
Name:DIABETIC SUPPLIES OF AMERICA, INC
Entity type:Organization
Organization Name:DIABETIC SUPPLIES OF AMERICA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARNER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-555-2561
Mailing Address - Street 1:802 OLD DIXIE HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2361
Mailing Address - Country:US
Mailing Address - Phone:800-555-2561
Mailing Address - Fax:561-840-1042
Practice Address - Street 1:802 OLD DIXIE HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2361
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:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8243OtherBCBS OF FLORIDA
FL06300700Medicaid
FL06300700Medicaid