Provider Demographics
NPI:1679341267
Name:DIABETIC CARE LLC
Entity Type:Organization
Organization Name:DIABETIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-564-2414
Mailing Address - Street 1:2807 ALLEN ST STE 2210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1031
Mailing Address - Country:US
Mailing Address - Phone:817-481-4000
Mailing Address - Fax:877-294-5802
Practice Address - Street 1:1600 LANCASTER DR STE 102
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3579
Practice Address - Country:US
Practice Address - Phone:817-481-4000
Practice Address - Fax:877-294-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty