Healthcare Provider Details

I. General information

NPI: 1205949625
Provider Name (Legal Business Name): PINE ISLAND DIABETIC SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COLONIAL BLVD SUITE 84
FORT MYERS FL
33907-1055
US

IV. Provider business mailing address

1400 COLONIAL BLVD SUITE 84
FORT MYERS FL
33907-1055
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-3131
  • Fax: 239-931-3133
Mailing address:
  • Phone: 239-931-3131
  • Fax: 239-931-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA ANN COBEY
Title or Position: PRESIDENT
Credential:
Phone: 239-931-3131