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General NPI Number Information
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NPI Number | 1619226487
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Entity Type | Organization
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Legal Business Name | A - Z DIABETES CARE CLUB LLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 500 EAGLES LANDING DR SUITE B
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City | LAKELAND
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State | FL
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Zip | 33810-2899
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Country | US
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Telephone | 863-808-5691
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Fax | 863-808-5692
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Provider Business Mailing Address
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Address Line | 500 EAGLES LANDING DR SUITE B
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City | LAKELAND
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State | FL
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Zip | 33810-2899
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Country | US
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Telephone | 863-808-5691
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Fax | 863-808-5692
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. JENNIFER C. PETERS
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Credential |
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Telephone | 615-815-3223
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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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