Provider Demographics
NPI:1003809328
Name:DIABETIC SUPPLY INSTITUTE INC
Entity Type:Organization
Organization Name:DIABETIC SUPPLY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-780-7081
Mailing Address - Street 1:20905 TORRENCE CHAPEL ROAD
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20905 TORRENCE CHAPEL RD
Practice Address - Street 2:SUITE 203B
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4300
Practice Address - Country:US
Practice Address - Phone:800-780-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703102Medicaid
SCDE1096Medicaid
SCDE1096Medicaid