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General NPI Number Information
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NPI Number | 1376596866
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Entity Type | Organization
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Legal Business Name | DIABETIC SUPPLIES AND MORE, INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 6230 MCLEOD DR # 140
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City | LAS VEGAS
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State | NV
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Zip | 89120-4049
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Country | US
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Telephone | 702-649-5600
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Fax | 702-736-2199
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Provider Business Mailing Address
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Address Line | 6230 MCLEOD DR # 140
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City | LAS VEGAS
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State | NV
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Zip | 89120-4049
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Country | US
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Telephone | 702-649-5600
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Fax | 702-736-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PHYLLIS DIANE JORDAN
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Credential |
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Telephone | 702-649-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MP00320
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License Number State | NV
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