Active NPI
Lake Diabetes Supply, Inc
- Durable Medical Equipment & Medical Supplies
- Daytona Beach Shores, FL
National Provider Identifier
1861487191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- LAKE DIABETES SUPPLY, INC
- Practice address
- 2555 S Atlantic Ave
Suite 1205
Daytona Beach Shores, FL 32118-5546 - Phone
- (386) 304-5941
- Fax
- (386) 304-5941
- NPI assigned
- Sep 13, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Richard B Hartwell
- Title
- President
- Phone
- (386) 304-5941
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | FL | Primary |
Addresses
Primary practice location
2555 S Atlantic Ave
Suite 1205
Daytona Beach Shores, FL 32118-5546
Mailing address
508 N Harbor City Blvd
Melbourne, FL 32935-6838
Phone (321) 255-9800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R9283 | Other | FL | BCBS IDENTIFIER |
National Provider Directory
National Provider Directory- Tax ID family
- Lake Diabetes Supply Inc
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Fort Myers, FL
- NPI 1326033648
-
- Health Educator
- Melbourne, FL
- NPI 1568763696
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1861487191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 N HARBOR CITY BLVD",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329356838",
"telephone_number": "321-255-9800",
"fax_number": "321-751-1145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 S ATLANTIC AVE",
"address_2": "SUITE 1205",
"city": "DAYTONA BEACH SHORES",
"state": "FL",
"postal_code": "321185546",
"telephone_number": "386-304-5941",
"fax_number": "386-304-5941"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE DIABETES SUPPLY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-13",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "HARTWELL",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "386-304-5941",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IDENTIFIER",
"identifier": "R9283",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach Shores, FL
- Inner Riches Osteopathic Medical Associates Inc
- Tara James, FNP
- Joanne Eash Chiropractic LLC (Daytona Beach Shores Chiropractic)
- Deborah Arlt Klug
- Athas Nicholas Kometas, DMD
- Lisa M Libby, RPH
- Jessica W. Macginnis, BCBA
- Marcella Scaccia Physician PLLC (Total Wellness & Healthy Aging)
- Marina Dental Center Inc.
- Madeline McCullen
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.