Provider Demographics
NPI:1740468875
Name:WESTERN DIABETIC DELIVERY SERVICE LLC
Entity type:Organization
Organization Name:WESTERN DIABETIC DELIVERY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-244-8421
Mailing Address - Street 1:217 NAVIDAD ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-2105
Mailing Address - Country:US
Mailing Address - Phone:979-244-8421
Mailing Address - Fax:979-245-2132
Practice Address - Street 1:217 NAVIDAD ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-2105
Practice Address - Country:US
Practice Address - Phone:979-244-8421
Practice Address - Fax:979-245-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193177602Medicaid
UT870661614002Medicaid
UTIDX42335OtherHEALTHY U
MS01671724Medicaid
MS01671724Medicaid