Healthcare Provider Details

I. General information

NPI: 1619956901
Provider Name (Legal Business Name): CAROLINA DIABETIC SUPPLY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N GLENBURNIE RD
NEW BERN NC
28560-2706
US

IV. Provider business mailing address

301 N GLENBURNIE RD
NEW BERN NC
28560-2706
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-2244
  • Fax: 252-633-4156
Mailing address:
  • Phone: 252-633-2244
  • Fax: 252-633-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DENISE LEONARD
Title or Position: OWNER
Credential:
Phone: 252-633-2244