Provider Demographics
NPI:1073571220
Name:NATIONWIDE DIABETES SUPPLY CENTER LLC
Entity Type:Organization
Organization Name:NATIONWIDE DIABETES SUPPLY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-400-4347
Mailing Address - Street 1:14200 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44401-8753
Mailing Address - Country:US
Mailing Address - Phone:866-400-4347
Mailing Address - Fax:
Practice Address - Street 1:14200 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:BERLIN CENTER
Practice Address - State:OH
Practice Address - Zip Code:44401-8753
Practice Address - Country:US
Practice Address - Phone:866-400-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5726860001Medicare NSC