Organization
DIABETIC SUPPLY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALLAS POWERS CPED (MANAGING PARTNER)
(616) 835-3304
Entity
Organization
Contact information
Practice address
6506 CERMAK RD, BERWYN, IL 60402-2323
(616) 835-3304
(312) 962-5724
Mailing address
6506 CERMAK RD, BERWYN, IL 60402-2323
(616) 835-3304
(312) 962-5724
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
212.000175
IL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
212.000175
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
212.000175
IL
335E00000X
Prosthetic/Orthotic Supplier
Primary
212.000175
IL
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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