Provider Demographics
NPI:1215161203
Name:NATIONWIDE DIABETIC, INC.
Entity type:Organization
Organization Name:NATIONWIDE DIABETIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-0680
Mailing Address - Street 1:777 SHOTGUN RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1940
Mailing Address - Country:US
Mailing Address - Phone:954-473-0680
Mailing Address - Fax:800-693-2696
Practice Address - Street 1:777 SHOTGUN RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1940
Practice Address - Country:US
Practice Address - Phone:954-473-0680
Practice Address - Fax:800-693-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6331400001Medicare NSC