MEDICARE: UNITED DIABETIC SUPPLIES

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	0924777	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2122925	OTHER		PK

General Provider Information

NPI Number	:	1013169408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED DIABETIC SUPPLIES

Provider Business Mailing Address
First Line	:	PO BOX 7272
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-7272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 NORTHPOINT PKWY STE 300
Second Line	:
City	:	W. PALM BEACH
State	:	FL
Zip	:	33407-1953
Country	:	US
Telephone Number	:	855-349-6800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL SPIVAK
Credential	:
Telephone Number	:	703-349-6800

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	02/20/2024

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