MEDICARE: DIABETIC 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	:	1932187879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC SUPPLY, INC.

Provider Business Mailing Address
First Line	:	7027 ANGLEWOOD LN
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-6533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 KILLEARN CENTER BLVD
Second Line	:	SUITE B3
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3467
Country	:	US
Telephone Number	:	850-907-2039
Fax Number	:	850-907-2094

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANITA BURNS
Credential	:
Telephone Number	:	850-907-2039

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	08/22/2020

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