Provider Demographics
NPI:1841360575
Name:CAROLINA DIABETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:CAROLINA DIABETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:843-421-7739
Mailing Address - Street 1:14323 OCEAN HWY # 17
Mailing Address - Street 2:SUITE 4121 LITCHFIELD EXCHANGE
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4817
Mailing Address - Country:US
Mailing Address - Phone:843-421-7739
Mailing Address - Fax:
Practice Address - Street 1:14323 OCEAN HWY # 17
Practice Address - Street 2:SUITE 4121 LITCHFIELD EXCHANGE
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4817
Practice Address - Country:US
Practice Address - Phone:843-421-7739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2891Medicaid
SC5833010001Medicare NSC