1508894114 NPI number — ACCESS DIABETIC SUPPLY LLC

Table of content: (NPI 1508894114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508894114 NPI number — ACCESS DIABETIC SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS DIABETIC SUPPLY LLC
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:
6
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:
1508894114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841657
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-1657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-975-2281
Provider Business Mailing Address Fax Number:
800-477-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 NW 33RD ST
Provider Second Line Business Practice Location Address:
STE 1000A
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33069-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-975-2281
Provider Business Practice Location Address Fax Number:
800-477-5801
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOCKSDALE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
DIVISION PRESIDENT
Authorized Official Telephone Number:
954-975-2281

Provider Taxonomy Codes

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

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

  • Identifier: 1118281 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 621773 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90003617 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0545533 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200340550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003110228 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1162329 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146034741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 568628 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806119600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: MS803FL , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009953365 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: XDME03002 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022513401 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001137316 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100403870A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 344347881A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96835249 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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