NPI Code Detail JSON Logo

1245484906 NPI number — DIABETES SPECIALTY CENTER LLC

NPI Number: 1245484906
Health Care Provider/Practitioner: DIABETES SPECIALTY CENTER LLC

Information about “1245484906” NPI (DIABETES SPECIALTY CENTER LLC) exists in 1245484906 in HTML format HTML  |  1245484906 in plain Text format TXT  |  1245484906 in PDF (Portable Document Format) PDF  |  1245484906 in an XML format XML  formats.

NPI Number : 1245484906 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245484906",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DIABETES SPECIALTY CENTER, LLC",
    "ParentOrgTIN": null,
    "OrgName": "DIABETES SPECIALTY CENTER LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3793 S STATE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84115-4828",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-392-2362",
    "MailingAddressFaxNumber": "801-392-5643",
    "FirstLinePracticeLocationAddress": "1254 N STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PROVO",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84604-6432",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-392-2362",
    "PracticeLocationAddressFaxNumber": "801-392-5643",
    "EnumerationDate": "11/07/2008",
    "LastUpdateDate": "03/16/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COHEN",
    "AuthorizedOfficialFirstName": "MARC",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "801-743-2800",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "335E00000X",
          "TaxonomyName": "Prosthetic/Orthotic Supplier",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.