Provider Demographics
NPI:1912699240
Name:TRUE DIABETES NEUROPATHY & WOUND SOLUTIONS AZ LLC
Entity Type:Organization
Organization Name:TRUE DIABETES NEUROPATHY & WOUND SOLUTIONS AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF INFORMATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-740-1910
Mailing Address - Street 1:5171 S CUB LAKE RD STE C330
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7997
Mailing Address - Country:US
Mailing Address - Phone:928-243-0348
Mailing Address - Fax:480-977-1138
Practice Address - Street 1:5171 S CUB LAKE RD STE C330
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7997
Practice Address - Country:US
Practice Address - Phone:928-243-0348
Practice Address - Fax:928-328-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1366183212OtherNPI
AZ1598314247OtherNPI