Provider Demographics
NPI:1568512853
Name:DIVERSIFIED MEDICAL SUPPLY
Entity type:Organization
Organization Name:DIVERSIFIED MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-398-5561
Mailing Address - Street 1:1880 DERBYSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3447
Mailing Address - Country:US
Mailing Address - Phone:407-398-5561
Mailing Address - Fax:407-332-8879
Practice Address - Street 1:478 E ALTAMONTE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4628
Practice Address - Country:US
Practice Address - Phone:407-398-5561
Practice Address - Fax:407-332-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6980136513745332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies