MEDICARE: FLORENCE DIABETIC MEDICAL SUPPLIES, 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	:	1629165055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORENCE DIABETIC MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	6073 NW 167TH ST
Second Line	:	UNIT C-7
City	:	HIALEAH
State	:	FL
Zip	:	33015-4336
Country	:	US
Telephone Number	:	305-557-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	6073 NW 167TH ST
Second Line	:	UNIT C-7
City	:	HIALEAH
State	:	FL
Zip	:	33015-4336
Country	:	US
Telephone Number	:	305-557-7009
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS E LOPEZ
Credential	:
Telephone Number	:	305-557-7009

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/28/2008

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