Healthcare Provider Details

I. General information

NPI: 1871052324
Provider Name (Legal Business Name): POPS DIABETES CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 MEMORIAL AVE N STE 2
OAK PARK HEIGHTS MN
55082-1087
US

IV. Provider business mailing address

5600 MEMORIAL AVE N STE 2
OAK PARK HEIGHTS MN
55082-1087
US

V. Phone/Fax

Practice location:
  • Phone: 800-767-7268
  • Fax:
Mailing address:
  • Phone: 800-767-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER CAO
Title or Position: OFFICE MANAGER
Credential:
Phone: 612-202-8502