Provider Demographics
NPI:1689782914
Name:DIABETES DIRECT INC
Entity type:Organization
Organization Name:DIABETES DIRECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:NETO
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-493-7624
Mailing Address - Street 1:PO BOX 8950
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-8950
Mailing Address - Country:US
Mailing Address - Phone:561-746-6754
Mailing Address - Fax:561-746-7961
Practice Address - Street 1:2915 JUPITER PARK DR
Practice Address - Street 2:SUITE 700
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8947
Practice Address - Country:US
Practice Address - Phone:561-746-6754
Practice Address - Fax:561-746-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4096620001Medicare NSC