Organization
DIABETES SPECIALTY CENTER LLC
Active
Parent organization
DIABETES SPECIALTY CENTER, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIABETES SPECIALTY CENTER, LLC
Authorized official
MR. MARC COHEN (PRESIDENT)
(801) 743-2800
Entity
Organization
Contact information
Practice address
1254 N STATE ST, PROVO, UT 84604-6432
(801) 392-2362
(801) 392-5643
Mailing address
3793 S STATE ST, SALT LAKE CITY, UT 84115-4828
(801) 392-2362
(801) 392-5643
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841279155
MEDICARE NPI
UT
05
—
5386155
—
UT
Enumeration date
11/07/2008
Last updated
03/16/2012
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