Provider Demographics
NPI:1316917354
Name:DIABETES PROVIDERS INC
Entity type:Organization
Organization Name:DIABETES PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:D ONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-689-4377
Mailing Address - Street 1:880 JUPITER PARK DR
Mailing Address - Street 2:UNIT #8
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8901
Mailing Address - Country:US
Mailing Address - Phone:800-689-4377
Mailing Address - Fax:800-887-6145
Practice Address - Street 1:880 JUPITER PARK DR
Practice Address - Street 2:UNIT #8
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8901
Practice Address - Country:US
Practice Address - Phone:800-689-4377
Practice Address - Fax:800-887-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04781701Medicaid
FL030959100Medicaid
FLR8807OtherBLUE CROSS
FL1018920001Medicare NSC