Provider Demographics
NPI:1275856247
Name:DIABETIC HEALTH, INC.
Entity Type:Organization
Organization Name:DIABETIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-598-8813
Mailing Address - Street 1:509 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6195
Mailing Address - Country:US
Mailing Address - Phone:606-598-8813
Mailing Address - Fax:606-598-0983
Practice Address - Street 1:509 MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6195
Practice Address - Country:US
Practice Address - Phone:606-598-8813
Practice Address - Fax:606-598-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710016290Medicaid
KY000000672417OtherANTHEM BLUE CROSS BLUE SHIELD
KYP100016258Medicare PIN