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General NPI Number Information
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NPI Number | 1760491898
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Entity Type | Organization
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Legal Business Name | DIABETIC AND MEDICAL RESOURCES CORP
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 3999 DUTCHMANS LN SUITE 3 F
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City | LOUISVILLE
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State | KY
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Zip | 40207-4714
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Country | US
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Telephone | 502-376-3979
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Fax | 502-899-5209
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Provider Business Mailing Address
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Address Line | 3999 DUTCHMANS LN STE. 3 F
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City | LOUISVILLE
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State | KY
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Zip | 40207
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Country | US
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Telephone | 502-376-3979
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Fax | 502-899-5209
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. YELENA VILDER
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Credential |
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Telephone | 502-376-3979
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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 | 051629
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License Number State | KY
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