Provider Demographics
NPI:1205949625
Name:PINE ISLAND DIABETIC SUPPLY INC
Entity type:Organization
Organization Name:PINE ISLAND DIABETIC SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-3131
Mailing Address - Street 1:1400 COLONIAL BLVD
Mailing Address - Street 2:SUITE 84
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1055
Mailing Address - Country:US
Mailing Address - Phone:239-931-3131
Mailing Address - Fax:239-931-3133
Practice Address - Street 1:1400 COLONIAL BLVD
Practice Address - Street 2:SUITE 84
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1055
Practice Address - Country:US
Practice Address - Phone:239-931-3131
Practice Address - Fax:239-931-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031381500Medicaid
1247580001Medicare NSC