Provider Demographics
NPI:1710913173
Name:A - Z DIABETES CARE CLUB LLC
Entity Type:Organization
Organization Name:A - Z DIABETES CARE CLUB LLC
Other - Org Name:DIABETES CARE CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-815-3223
Mailing Address - Street 1:6840 CAROTHERS PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6390
Mailing Address - Country:US
Mailing Address - Phone:615-226-2221
Mailing Address - Fax:800-580-5680
Practice Address - Street 1:6840 CAROTHERS PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6390
Practice Address - Country:US
Practice Address - Phone:615-226-2221
Practice Address - Fax:800-580-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110755332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4415480001Medicare NSC