Provider Demographics
NPI:1073569380
Name:DIABETES CARE & EDUCATION INC
Entity Type:Organization
Organization Name:DIABETES CARE & EDUCATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-903-5000
Mailing Address - Street 1:13621 NW 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2836
Mailing Address - Country:US
Mailing Address - Phone:954-903-5000
Mailing Address - Fax:954-903-5290
Practice Address - Street 1:10101 LINN STATION RD
Practice Address - Street 2:SUITE 525
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3848
Practice Address - Country:US
Practice Address - Phone:502-426-4842
Practice Address - Fax:502-426-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY069584332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271480AMedicaid
KY90000266Medicaid
KY1138000002Medicare NSC