Provider Demographics
NPI:1538202460
Name:DIABETIC CARE SERVICE INC.
Entity type:Organization
Organization Name:DIABETIC CARE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-5310
Mailing Address - Street 1:96 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2407
Mailing Address - Country:US
Mailing Address - Phone:239-275-4905
Mailing Address - Fax:239-275-5478
Practice Address - Street 1:96 2ND ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2407
Practice Address - Country:US
Practice Address - Phone:239-275-4905
Practice Address - Fax:239-275-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
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
FL1013220001Medicare ID - Type UnspecifiedHIC