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General NPI Number Information
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NPI Number | 1003901406
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Entity Type | Organization
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Legal Business Name | DIAMOND PT DIABETIC SUPPL
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 149 WALKER ROAD
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City | CAMPOBELLO
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State | SC
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Zip | 29322-9053
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Country | US
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Telephone | 864-472-5517
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Fax | 864-278-0650
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Provider Business Mailing Address
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Address Line | 149 WALKER ROAD
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City | CAMPOBELLO
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State | SC
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Zip | 29322-9053
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Country | US
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Telephone | 864-472-5517
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Fax | 864-278-0650
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL MOORE III
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Credential | C. PED
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Telephone | 864-472-5517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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