Organization
DIAMOND PT DIABETIC SUPPL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL MOORE III C. PED (PRESIDENT)
(864) 472-5517
Entity
Organization
Contact information
Practice address
149 WALKER ROAD, CAMPOBELLO, SC 29322-9053
(864) 472-5517
(864) 278-0650
Mailing address
149 WALKER ROAD, CAMPOBELLO, SC 29322-9053
(864) 472-5517
(864) 278-0650
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE2529
—
SC
Enumeration date
10/03/2006
Last updated
02/14/2008
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