Provider Demographics
NPI:1679588099
Name:CENTURY DIABETIC SUPPLY, INC
Entity type:Organization
Organization Name:CENTURY DIABETIC SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-519-6484
Mailing Address - Street 1:1100 NE 125TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5044
Mailing Address - Country:US
Mailing Address - Phone:305-981-1066
Mailing Address - Fax:305-981-1064
Practice Address - Street 1:1100 NE 125TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5044
Practice Address - Country:US
Practice Address - Phone:305-981-1066
Practice Address - Fax:305-981-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies