MEDICARE: DIABETES RESOURCE CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356398929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES RESOURCE CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 6337
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-0337
Country	:	US
Telephone Number	:	502-895-2334
Fax Number	:	502-896-6987

Provider Business Practice Location Address
First Line	:	920 DUPONT RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4692
Country	:	US
Telephone Number	:	502-895-2334
Fax Number	:	502-896-6987

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MS. EMILIA A GRABOWSKI
Credential	:
Telephone Number	:	502-895-2334

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

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