Provider Demographics
NPI:1336345222
Name:CYNTRIST, LLC
Entity Type:Organization
Organization Name:CYNTRIST, LLC
Other - Org Name:TOTAL HEALTH DIABETES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-728-2788
Mailing Address - Street 1:P.O. BOX 941960
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1960
Mailing Address - Country:US
Mailing Address - Phone:800-728-2788
Mailing Address - Fax:866-991-0388
Practice Address - Street 1:761 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:800-728-2788
Practice Address - Fax:866-991-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5942390001Medicare NSC