Provider Demographics
NPI:1710173349
Name:DIABETES CARE SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:DIABETES CARE SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CDE
Authorized Official - Phone:502-349-0105
Mailing Address - Street 1:120 W STEPHEN FOSTER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1465
Mailing Address - Country:US
Mailing Address - Phone:502-349-0105
Mailing Address - Fax:502-349-0170
Practice Address - Street 1:120 W STEPHEN FOSTER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1465
Practice Address - Country:US
Practice Address - Phone:502-349-0105
Practice Address - Fax:502-349-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3072PKY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00522OtherGROUP