Provider Demographics
NPI:1497746085
Name:DIABETES CARE CENTER
Entity Type:Organization
Organization Name:DIABETES CARE CENTER
Other - Org Name:DIABETES CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JETE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-2595
Mailing Address - Street 1:1792 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3622
Mailing Address - Country:US
Mailing Address - Phone:256-737-2025
Mailing Address - Fax:256-737-2829
Practice Address - Street 1:1792 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3622
Practice Address - Country:US
Practice Address - Phone:256-737-2025
Practice Address - Fax:256-737-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH0S0035HMedicaid
AL010049OtherBLUE CROSS
AL010035Medicare ID - Type Unspecified