Provider Demographics
NPI:1710323282
Name:DIABETES SPECIALTY CENTER, LLC
Entity Type:Organization
Organization Name:DIABETES SPECIALTY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-743-2800
Mailing Address - Street 1:645 E 4500 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2951
Mailing Address - Country:US
Mailing Address - Phone:801-743-2800
Mailing Address - Fax:801-743-2801
Practice Address - Street 1:645 E 4500 S
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2951
Practice Address - Country:US
Practice Address - Phone:801-743-2800
Practice Address - Fax:801-743-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies