Healthcare Provider Details

I. General information

NPI: 1710323282
Provider Name (Legal Business Name): DIABETES SPECIALTY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E 4500 S SUITE 200
SALT LAKE CITY UT
84107-2951
US

IV. Provider business mailing address

645 E 4500 S SUITE 200
SALT LAKE CITY UT
84107-2951
US

V. Phone/Fax

Practice location:
  • Phone: 801-743-2800
  • Fax: 801-743-2801
Mailing address:
  • Phone: 801-743-2800
  • Fax: 801-743-2801

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: MARC COHEN
Title or Position: CEO
Credential:
Phone: 801-743-2800