Provider Demographics
NPI:1437385069
Name:AJT DIABETIC INCORPORATED
Entity Type:Organization
Organization Name:AJT DIABETIC INCORPORATED
Other - Org Name:COUNTRYWIDE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOBLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-441-1621
Mailing Address - Street 1:8500 ALMEDA GENOA RD
Mailing Address - Street 2:SUITE 112A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2223
Mailing Address - Country:US
Mailing Address - Phone:713-440-9090
Mailing Address - Fax:
Practice Address - Street 1:8500 ALMEDA GENOA RD
Practice Address - Street 2:SUITE 112A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2223
Practice Address - Country:US
Practice Address - Phone:713-440-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000026332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6314070001Medicare NSC