MEDICARE: DIABETES HEALTH CENTERS 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	MP00373	NV

General Provider Information

NPI Number	:	1982666947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES HEALTH CENTERS INC

Provider Business Mailing Address
First Line	:	2550 S RAINBOW BLVD
Second Line	:	STE. E19
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5175
Country	:	US
Telephone Number	:	702-257-9713
Fax Number	:	702-968-9988

Provider Business Practice Location Address
First Line	:	2550 S RAINBOW BLVD
Second Line	:	STE E19
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5175
Country	:	US
Telephone Number	:	702-257-9713
Fax Number	:	702-968-9988

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. THOMAS W SHAFFER
Credential	:
Telephone Number	:	702-257-9713

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/15/2007

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