Provider Demographics
NPI:1497780969
Name:DIABETIC SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:DIABETIC SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:704-892-2800
Mailing Address - Street 1:19837 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8515
Mailing Address - Country:US
Mailing Address - Phone:704-892-2800
Mailing Address - Fax:704-892-2804
Practice Address - Street 1:19837 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8515
Practice Address - Country:US
Practice Address - Phone:704-892-2800
Practice Address - Fax:704-892-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00986332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1112000001Medicare ID - Type UnspecifiedSUBMITTER ID