MEDICARE: DIABETIC EQUIPMENT AND SUPPLIES LLC

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	:	1710503693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC EQUIPMENT AND SUPPLIES LLC

Provider Business Mailing Address
First Line	:	6445 CORPORATE DR
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1658
Country	:	US
Telephone Number	:	515-478-3600
Fax Number	:	515-478-3601

Provider Business Practice Location Address
First Line	:	1206 W MAUMEE ST STE H
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703-1347
Country	:	US
Telephone Number	:	463-777-9940
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCUS MILLER
Credential	:
Telephone Number	:	515-478-3600

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/19/2026

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