Life Care Diabetic Supplies, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1312919 Issued in FL

Legal business name

LIFE CARE DIABETIC SUPPLIES, INC.

Practice address

840 Jupiter Park Dr
Suite 101
Jupiter, FL 33458-8947

Phone

(561) 745-7335

Fax

(561) 427-6427

NPI assigned

May 28, 2006

Last updated

Jun 30, 2014By 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

Mrs. Biby Davila Jacoby

Title

President

Phone

(561) 745-7338

Specialties & licenses 1

Addresses

Other identifiers 14

Locations

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1689621393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 641",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334680641",
            "telephone_number": "561-745-7338",
            "fax_number": "561-427-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 JUPITER PARK DR",
            "address_2": "SUITE 101",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588947",
            "telephone_number": "561-745-7335",
            "fax_number": "561-427-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE DIABETIC SUPPLIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "BIBY",
        "authorized_official_middle_name": "DAVILA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-745-7338",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "1312919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401094900",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143776601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7821760",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200008430A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567602",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031242800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443086700",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1469017",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200304520A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "845265155",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HME LICENSE",
            "identifier": "1312919",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90011446",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9982460",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000326697C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Jupiter, FL
• Providers in Jupiter, 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 Jun 30, 2014; 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.