MEDICARE: DIABETECH, LP

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1467460881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETECH, LP

Provider Business Mailing Address
First Line	:	6301 GASTON AVE
Second Line	:	STE 158P
City	:	DALLAS
State	:	TX
Zip	:	75214-3922
Country	:	US
Telephone Number	:	877-694-5826
Fax Number	:	866-434-7314

Provider Business Practice Location Address
First Line	:	6301 GASTON AVE
Second Line	:	STE 158P
City	:	DALLAS
State	:	TX
Zip	:	75214-3922
Country	:	US
Telephone Number	:	877-694-5826
Fax Number	:	866-434-7314

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEVIN LEE MCMAHON
Credential	:
Telephone Number	:	469-235-1668

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/22/2008

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