Provider Demographics
NPI:1245509975
Name:DIABETES CARE SOLUTION, LLC
Entity type:Organization
Organization Name:DIABETES CARE SOLUTION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BAGNET-FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, CDE
Authorized Official - Phone:985-687-1557
Mailing Address - Street 1:19100 DR JOHN LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0922
Mailing Address - Country:US
Mailing Address - Phone:985-247-4567
Mailing Address - Fax:985-467-0896
Practice Address - Street 1:19100 DR JOHN LAMBERT DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0922
Practice Address - Country:US
Practice Address - Phone:985-247-4567
Practice Address - Fax:985-467-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2198157Medicaid
LA5DY05Medicare UPIN
LA2198157Medicaid