Provider Demographics
NPI:1861443491
Name:DISCOUNT DIABETIC LLC
Entity Type:Organization
Organization Name:DISCOUNT DIABETIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-314-0181
Mailing Address - Street 1:15255 N 40TH STREET
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:480-314-0181
Mailing Address - Fax:480-314-0184
Practice Address - Street 1:15255 N 40TH STREET
Practice Address - Street 2:SUITE 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:480-314-0181
Practice Address - Fax:480-314-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4386240001Medicare NSC
AZ4386240001Medicare NSC