MEDICARE: DIABETIC SUPPLY FOUNDATION OF FT MYERS

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	032752	FL

General Provider Information

NPI Number	:	1598862245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC SUPPLY FOUNDATION OF FT MYERS

Provider Business Mailing Address
First Line	:	205 JOEL BLVD
Second Line	:	SUITE 202
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-0201
Country	:	US
Telephone Number	:	239-848-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 JOEL BLVD
Second Line	:	SUITE 202
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-0201
Country	:	US
Telephone Number	:	239-848-6696
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. YVONNE TANENBAUM
Credential	:
Telephone Number	:	800-238-8944

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	08/22/2020

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