Provider Demographics
NPI:1265547889
Name:DIABETIC SERVICES INC
Entity type:Organization
Organization Name:DIABETIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-292-0200
Mailing Address - Street 1:PO BOX 26991
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0991
Mailing Address - Country:US
Mailing Address - Phone:864-292-0200
Mailing Address - Fax:864-292-0021
Practice Address - Street 1:202 BENDINGWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687
Practice Address - Country:US
Practice Address - Phone:864-292-0200
Practice Address - Fax:864-292-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0982Medicaid
SCDM0982Medicaid