Organization
DIABETES SPECIALTY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM E DOMAN (CONTROLLER)
(801) 263-5442
Entity
Organization
Contact information
Practice address
3793 SOUTH STATE STREET, SALT LAKE CITY, UT 84115-4828
(801) 268-9699
(801) 268-9929
Mailing address
3793 SOUTH STATE STREET, SALT LAKE CITY, UT 84115
(801) 268-9699
(801) 268-9929
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4781762-0160
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184127915501
—
UT
Enumeration date
01/13/2006
Last updated
04/24/2012
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