Provider Demographics
NPI:1255644399
Name:DIABETIX
Entity type:Organization
Organization Name:DIABETIX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-290-9756
Mailing Address - Street 1:1301 BEVILLE, ROAD
Mailing Address - Street 2:STE 17
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119
Mailing Address - Country:US
Mailing Address - Phone:386-290-9756
Mailing Address - Fax:
Practice Address - Street 1:1301 BEVILLE RD
Practice Address - Street 2:STE 17
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119
Practice Address - Country:US
Practice Address - Phone:386-290-9756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies