Healthcare Provider Details

I. General information

NPI: 1487784948
Provider Name (Legal Business Name): DIABETIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 UPPER VALLEY PIKE
SPRINGFIELD OH
45504-4030
US

IV. Provider business mailing address

1710 UPPER VALLEY PIKE
SPRINGFIELD OH
45504-4030
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-8800
  • Fax: 937-342-8805
Mailing address:
  • Phone: 937-342-8800
  • Fax: 937-342-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number128
License Number StateOH

VIII. Authorized Official

Name: ROBERT Q BAKER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 937-342-8800