MEDICARE: DIABETES EXPRESS SUPPLY CO. 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	10-00733-137	LA

General Provider Information

NPI Number	:	1821007386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES EXPRESS SUPPLY CO. INC

Provider Business Mailing Address
First Line	:	4560 NORTH BLVD. STE 102-B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-925-2232
Fax Number	:	225-926-4713

Provider Business Practice Location Address
First Line	:	4560 NORTH BLVD STE 102-B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-925-2232
Fax Number	:	225-926-4713

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KENDRICK M EBANKS
Credential	:	MSW, GSW
Telephone Number	:	225-925-2232

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/14/2008

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