=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710913173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A - Z DIABETES CARE CLUB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6840 CAROTHERS PKWY SUITE 600
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-6390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-226-2221
-----------------------------------------------------
Fax | 800-580-5680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6840 CAROTHERS PKWY SUITE 600
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-6390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-226-2221
-----------------------------------------------------
Fax | 800-580-5680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MRS. JENNIFER C. PETERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-815-3223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 110755
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------