Organization
A1 DIABETES & MEDICAL SUPPLY, INC.
Active
Other names
Lake Diabetes & Medical Supply, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E HENNESSY (PRESIDENT)
(321) 255-9800
Entity
Organization
Contact information
Practice address
636 S BAY ST, EUSTIS, FL 32726-4860
(352) 589-1177
(352) 589-0629
Mailing address
2092 SARNO RD, MELBOURNE, FL 32935-3077
(321) 255-9800
(321) 751-1145
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R6834
BCBS IDENTIFIER
FL
Enumeration date
09/08/2005
Last updated
07/21/2022
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