Organization
DIABETIC AND MEDICAL RESOURCES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YELENA VILDER (PRESIDENT)
(502) 376-3979
Entity
Organization
Contact information
Practice address
3999 DUTCHMANS LN, SUITE 3 F, LOUISVILLE, KY 40207-4714
(502) 376-3979
(502) 899-5209
Mailing address
3999 DUTCHMANS LN, STE. 3 F, LOUISVILLE, KY 40207
(502) 376-3979
(502) 899-5209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
051629
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384504
DME/BCBS
KY
05
—
200511350A
—
IN
01
—
2638618000
DME/PASSPORT ADVANTAGE
KY
05
—
50008839
—
KY
05
—
90011305
—
KY
Enumeration date
08/07/2006
Last updated
08/02/2011
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