Provider Demographics
NPI:1346254620
Name:DIABETES SUPPLY CENTER OF THE MIDLANDS LLC
Entity Type:Organization
Organization Name:DIABETES SUPPLY CENTER OF THE MIDLANDS LLC
Other - Org Name:DIABETES SUPPLY CENTER OF THE MIDLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:2910 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3213
Mailing Address - Country:US
Mailing Address - Phone:402-399-8444
Mailing Address - Fax:402-399-8616
Practice Address - Street 1:10304 CROWN POINT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1060
Practice Address - Country:US
Practice Address - Phone:402-399-8444
Practice Address - Fax:402-399-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0987867Medicaid
NE09931OtherBCBS
NE2815035OtherNABP NUMBER
NE=========50Medicaid
NE0338780001Medicare NSC