MEDICARE: DILIGENT MEDICAL SUPPLY

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	:	1720667025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILIGENT MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	5757 BOOTH RD BLDG 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5981
Country	:	US
Telephone Number	:	904-425-1414
Fax Number	:	904-425-2055

Provider Business Practice Location Address
First Line	:	5757 BOOTH RD BLDG 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5981
Country	:	US
Telephone Number	:	904-425-1414
Fax Number	:	904-425-2055

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. NEVILLE NKAFU NJIKEM
Credential	:	MHA
Telephone Number	:	347-607-7031

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	01/29/2024

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