MEDICARE: DIABETIC HEALTH SUPPLY, 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	5282130001	FL

General Provider Information

NPI Number	:	1750385035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC HEALTH SUPPLY, INC

Provider Business Mailing Address
First Line	:	9031 PITTSBURGH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-7206
Country	:	US
Telephone Number	:	239-437-4004
Fax Number	:	239-437-4008

Provider Business Practice Location Address
First Line	:	9031 PITTSBURGH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-7206
Country	:	US
Telephone Number	:	239-437-4004
Fax Number	:	239-437-4008

Authorized Official
Title or Position	:	PRESIDENT/CUSTOMER SERVICE MANAGER
Name	:	LYNN C REDAVID
Credential	:
Telephone Number	:	239-437-4004

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/22/2020

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