MEDICARE: DIABETIC SUPPLIES AND MORE, 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	MP00320	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376596866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC SUPPLIES AND MORE, INC

Provider Business Mailing Address
First Line	:	6230 MCLEOD DR
Second Line	:	# 140
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4049
Country	:	US
Telephone Number	:	702-649-5600
Fax Number	:	702-736-2199

Provider Business Practice Location Address
First Line	:	6230 MCLEOD DR
Second Line	:	# 140
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4049
Country	:	US
Telephone Number	:	702-649-5600
Fax Number	:	702-736-2199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. PHYLLIS DIANE JORDAN
Credential	:
Telephone Number	:	702-649-5600

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/01/2009

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