Provider Demographics
NPI:1962476754
Name:COMPLETE DIABETIC SYSTEMS INC
Entity type:Organization
Organization Name:COMPLETE DIABETIC SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:180-098-5640
Mailing Address - Street 1:18067 AVONSDALE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-9503
Mailing Address - Country:US
Mailing Address - Phone:180-098-5640
Mailing Address - Fax:941-629-2470
Practice Address - Street 1:18067 AVONSDALE CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-9503
Practice Address - Country:US
Practice Address - Phone:180-098-5640
Practice Address - Fax:941-629-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1095520001Medicare ID - Type Unspecified