101 Diabetic Supplies, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

101 DIABETIC SUPPLIES, LLC

Practice address

1400 White Dr Ste B
Titusville, FL 32780-9657

Phone

(321) 676-8989

NPI assigned

Jun 15, 2011

Last updated

Aug 23, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dale Greyslak

Title

Managing Member

Phone

(321) 267-7576

Specialties & licenses 1

Addresses

Other names 1

• Jade Diabetic Group Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1003101296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WHITE DR STE B",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327809657",
            "telephone_number": "321-676-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 WHITE DR STE B",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327809657",
            "telephone_number": "321-676-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "101 DIABETIC SUPPLIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "GREYSLAK",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "321-267-7576",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jade Diabetic Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Titusville, FL
• Providers in Titusville, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.