Provider Demographics
NPI:1225081847
Name:CAROLINA DIABETIC SUPPLY, INC.
Entity Type:Organization
Organization Name:CAROLINA DIABETIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-931-0953
Mailing Address - Street 1:PO BOX 3308
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3308
Mailing Address - Country:US
Mailing Address - Phone:803-931-0953
Mailing Address - Fax:803-931-0954
Practice Address - Street 1:124 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6503
Practice Address - Country:US
Practice Address - Phone:803-931-0953
Practice Address - Fax:803-931-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0794Medicaid
SCDM0794Medicaid