Provider Demographics
NPI:1902833270
Name:DIABETIC TREATMENT CENTERS OF AMERICA
Entity Type:Organization
Organization Name:DIABETIC TREATMENT CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-746-0407
Mailing Address - Street 1:50 S 900 E
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1366
Mailing Address - Country:US
Mailing Address - Phone:801-746-0407
Mailing Address - Fax:801-575-5462
Practice Address - Street 1:50 S 900 E
Practice Address - Street 2:SUITE 1A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1366
Practice Address - Country:US
Practice Address - Phone:801-746-0407
Practice Address - Fax:801-575-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center