Provider Demographics
NPI:1801966957
Name:DIABETIC MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:DIABETIC MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-345-8787
Mailing Address - Street 1:2830 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1425
Mailing Address - Country:US
Mailing Address - Phone:954-345-8787
Mailing Address - Fax:954-344-6654
Practice Address - Street 1:2830 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1425
Practice Address - Country:US
Practice Address - Phone:954-345-8787
Practice Address - Fax:954-344-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
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
FL1091160001Medicare ID - Type Unspecified