Provider Demographics
NPI:1164460747
Name:MEDSTAR DIABETIC SUPPLY, LP
Entity type:Organization
Organization Name:MEDSTAR DIABETIC SUPPLY, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-628-2100
Mailing Address - Street 1:160 FOUNTAIN PKWY N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1411
Mailing Address - Country:US
Mailing Address - Phone:972-628-2100
Mailing Address - Fax:
Practice Address - Street 1:3939 W. GREEN OAKS BLVD
Practice Address - Street 2:#205
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2793
Practice Address - Country:US
Practice Address - Phone:866-535-5556
Practice Address - Fax:866-535-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017085402Medicaid
AL009938430Medicaid
AR141003716Medicaid
NM55424279Medicaid
OK100815120AMedicaid
NC1164460747Medicaid
TX017085403Medicaid
OK100815120AMedicaid
LA1450901Medicaid
NM55424279Medicaid
TX017085402Medicaid