MEDICARE: DIABETIC MEDICAL SUPPLY, 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	:	1801966957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2830 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-1425
Country	:	US
Telephone Number	:	954-345-8787
Fax Number	:	954-344-6654

Provider Business Practice Location Address
First Line	:	2830 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-1425
Country	:	US
Telephone Number	:	954-345-8787
Fax Number	:	954-344-6654

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RON RUDDERMAN
Credential	:
Telephone Number	:	954-345-8787

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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