Provider Demographics
NPI:1295849453
Name:DIABETIC WAREHOUSE, LLC
Entity Type:Organization
Organization Name:DIABETIC WAREHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-474-3300
Mailing Address - Street 1:3839 OLD US HWY 45 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-474-3300
Mailing Address - Fax:601-474-3317
Practice Address - Street 1:3839 OLD US HWY 45 N
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-474-3300
Practice Address - Fax:601-474-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0448480-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469866Medicaid
MS5153000002Medicare NSC