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NPI Code Detail

MEDICARE: INNOVATIVE DIABETIC CENTER, LLC

MEDICARE: INNOVATIVE DIABETIC CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133VN1006XMetabolic Nutrition Registered Dietitian
2133N00000XNutritionist
3164W00000XLicensed Practical Nurse
4261QI0500XInfusion Therapy Clinic/Center
5163WI0500XInfusion Therapy Registered Nurse
6261QM1300XMulti-Specialty Clinic/Center
7163WD0400XDiabetes Educator Registered Nurse
8208VP0000XPain Medicine Physician
92081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician
10363L00000XNurse Practitioner
11207RE0101XEndocrinology, Diabetes & Metabolism Physician
12207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1235997602
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE DIABETIC CENTER, LLC
Provider Business Mailing Address
First Line : 10210 N 92ND ST STE 104
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4531
Country : US
Telephone Number : 480-493-0900
Fax Number : 833-228-0846
Provider Business Practice Location Address
First Line : 10210 N 92ND ST STE 104
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4531
Country : US
Telephone Number : 480-493-0900
Fax Number : 833-228-0846
Authorized Official
Title or Position : PRESIDENT
Name : AMY LORRAINE HUNN
Credential :
Telephone Number : 480-493-0900
Provider Enumeration Date : 03/11/2024
Last Update Date : 12/31/2025

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