Diabetes Store, Incorporated

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

DIABETES STORE, INCORPORATED

Doing business as

Diabetes Store, Inc.

Practice address

777 Deltona Blvd Ste 4
Deltona, FL 32725-7174

Phone

(901) 312-3150

Fax

(800) 208-0863

NPI assigned

Nov 11, 2019

Organization subpart

No

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

Authorized official

Name

Craig Brosseau

Title

Secretary

Phone

(952) 646-3255

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Diabetes Store, Inc. Doing business as

Locations

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1417592726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 MORIAH WOODS BLVD STE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381177128",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 DELTONA BLVD STE 4",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327257174",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES STORE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-11",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "BROSSEAU",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-646-3255"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "4425570004",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Store, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Diabetes Store, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Deltona, FL
• Providers in Deltona, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; 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.