Provider Demographics
NPI:1336272475
Name:DIABETES CONTROL CENTER INC
Entity Type:Organization
Organization Name:DIABETES CONTROL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:360-479-8881
Mailing Address - Street 1:702 LEBO BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3370
Mailing Address - Country:US
Mailing Address - Phone:360-479-8881
Mailing Address - Fax:360-479-8882
Practice Address - Street 1:702 LEBO BLVD STE B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3370
Practice Address - Country:US
Practice Address - Phone:360-479-8881
Practice Address - Fax:360-479-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9057225Medicaid
WA5557650001Medicare NSC