1154958650 NPI number — DIMA MEDICAL SUPPLIES, INC

Table of content: DR. KYLE JAY KLAHS DO (NPI 1710476528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154958650 NPI number — DIMA MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIMA MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154958650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3512 18TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33976-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-647-6004
Provider Business Mailing Address Fax Number:
786-796-7769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3512 18TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33976-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-647-6004
Provider Business Practice Location Address Fax Number:
786-796-7769
Provider Enumeration Date:
03/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GARRIDO BLANCO
Authorized Official First Name:
DIDIET
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-978-1585

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114932600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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