Healthcare Provider Details

I. General information

NPI: 1003809328
Provider Name (Legal Business Name): DIABETIC SUPPLY INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 TORRENCE CHAPEL RD SUITE 203B
CORNELIUS NC
28031-4300
US

IV. Provider business mailing address

20905 TORRENCE CHAPEL ROAD SUITE 203B
CORNELIUS NC
28031
US

V. Phone/Fax

Practice location:
  • Phone: 800-780-7081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC

VIII. Authorized Official

Name: THOMAS JOSEPH MINI
Title or Position: PRESIDENT
Credential:
Phone: 800-780-7081