Provider Demographics
NPI:1366650624
Name:DIABETES SPECIALTY CENTER LLC
Entity Type:Organization
Organization Name:DIABETES SPECIALTY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CUSTOMER SERVICE MANAGER COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCGUIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-9699
Mailing Address - Street 1:3793 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4828
Mailing Address - Country:US
Mailing Address - Phone:801-268-9699
Mailing Address - Fax:801-268-9929
Practice Address - Street 1:3955 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2313
Practice Address - Country:US
Practice Address - Phone:801-392-2362
Practice Address - Fax:801-392-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1841279155OtherNPI FOR PARENT COMPANY
UT3851290001Medicare ID - Type Unspecified