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General NPI Number Information
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NPI Number | 1841279155
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Entity Type | Organization
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Legal Business Name | DIABETES SPECIALTY CENTER LLC
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 3793 SOUTH STATE STREET
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-4828
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Country | US
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Telephone | 801-268-9699
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Fax | 801-268-9929
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Provider Business Mailing Address
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Address Line | 3793 SOUTH STATE STREET
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City | SALT LAKE CITY
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State | UT
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Zip | 84115
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Country | US
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Telephone | 801-268-9699
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Fax | 801-268-9929
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Authorized Official
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Title or Position | CONTROLLER
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Name | MS. KIM E DOMAN
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Credential |
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Telephone | 801-263-5442
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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 | 4781762-0160
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License Number State | UT
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