Provider Demographics
NPI:1891840047
Name:ACCESS DIABETIC SUPPLY
Entity type:Organization
Organization Name:ACCESS DIABETIC SUPPLY
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:954-975-2281
Mailing Address - Street 1:PO BOX 28545
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102-8545
Mailing Address - Country:US
Mailing Address - Phone:954-975-2281
Mailing Address - Fax:800-477-5801
Practice Address - Street 1:1801 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1323
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:2007-01-25
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies