Healthcare Provider Details

I. General information

NPI: 1073571220
Provider Name (Legal Business Name): NATIONWIDE DIABETES SUPPLY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 ELLSWORTH RD
BERLIN CENTER OH
44401-8753
US

IV. Provider business mailing address

14200 ELLSWORTH RD
BERLIN CENTER OH
44401-8753
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-4347
  • Fax:
Mailing address:
  • Phone: 866-400-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JASON M ROTH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 866-400-4347