Organization
THE DIABETIC SUPER STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS M COX (CEO)
(865) 717-1144
Entity
Organization
Contact information
Practice address
164 E RACE ST, KINGSTON, TN 37763-2823
(865) 717-1144
(865) 717-0184
Mailing address
164 E RACE ST, KINGSTON, TN 37763-2823
(865) 717-1144
(865) 717-0184
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454421
—
TN
01
—
4082388
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/16/2006
Last updated
08/22/2020
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