MEDICARE: CERTIFIED DIABETIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053319137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED DIABETIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	3030 HORSESHOE DR S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-6139
Country	:	US
Telephone Number	:	239-430-5000
Fax Number	:	239-403-7722

Provider Business Practice Location Address
First Line	:	3030 HORSESHOE DR S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-6143
Country	:	US
Telephone Number	:	239-430-5000
Fax Number	:	239-403-7722

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. BRENT PETERSON
Credential	:
Telephone Number	:	239-430-5000

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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