Provider Demographics
NPI:1427071364
Name:KEY DIABETES SUPPLY CO
Entity type:Organization
Organization Name:KEY DIABETES SUPPLY CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:STOCKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-975-0036
Mailing Address - Street 1:PO BOX 841689
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1689
Mailing Address - Country:US
Mailing Address - Phone:954-975-2281
Mailing Address - Fax:800-477-5801
Practice Address - Street 1:11585 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-5729
Practice Address - Country:US
Practice Address - Phone:954-975-2281
Practice Address - Fax:800-477-5801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWENS & MINOR HEALTHCARE SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4415845Medicaid
MI4478470001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #