Provider Demographics
NPI:1497785182
Name:COMPREHENSIVE DIABETIC SOLUTIONS
Entity Type:Organization
Organization Name:COMPREHENSIVE DIABETIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-327-9440
Mailing Address - Street 1:3251 POPLAR AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3609
Mailing Address - Country:US
Mailing Address - Phone:901-327-9440
Mailing Address - Fax:901-452-6081
Practice Address - Street 1:3251 POPLAR AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3609
Practice Address - Country:US
Practice Address - Phone:901-327-9440
Practice Address - Fax:901-452-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000868332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000004446OtherPHARMACY
TN1455061Medicaid
TN1455061Medicaid