Provider Demographics
NPI:1992799787
Name:A1 DIABETES & MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:A1 DIABETES & MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-325-6047
Mailing Address - Street 1:1785 NONCONNAH BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2104
Mailing Address - Country:US
Mailing Address - Phone:800-316-7955
Mailing Address - Fax:888-491-3050
Practice Address - Street 1:1785 NONCONNAH BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2104
Practice Address - Country:US
Practice Address - Phone:800-316-7955
Practice Address - Fax:888-491-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9284OtherBLUE CROSS BLUE SHIELD
FL0195730003Medicare ID - Type UnspecifiedMEDICARE PARTICIPATING