MEDICARE: DIASUPPLY 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

General Provider Information

NPI Number	:	1225360365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIASUPPLY INC.

Provider Business Mailing Address
First Line	:	639 E OCEAN AVE
Second Line	:	SUITE 301
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-5011
Country	:	US
Telephone Number	:	561-733-6660
Fax Number	:	866-769-9294

Provider Business Practice Location Address
First Line	:	639 E OCEAN AVE
Second Line	:	SUITE 301
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-5011
Country	:	US
Telephone Number	:	561-733-6660
Fax Number	:	866-769-9294

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS A HAUCK
Credential	:
Telephone Number	:	561-733-6660

Provider Enumeration Date	:	01/30/2010
Last Update Date	:	01/30/2010

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