Provider Demographics
NPI:1336196997
Name:DIABETES CLINICAL SERVICES, PSC
Entity Type:Organization
Organization Name:DIABETES CLINICAL SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRABOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:502-895-2334
Mailing Address - Street 1:PO BOX 6337
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0337
Mailing Address - Country:US
Mailing Address - Phone:502-895-2334
Mailing Address - Fax:502-896-6987
Practice Address - Street 1:4010 DANA RD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9224
Practice Address - Country:US
Practice Address - Phone:502-895-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8696Medicare PIN
KY8696Medicare PIN
KY8696Medicare ID - Type UnspecifiedGROUP MEDICARE PROVIDER #