Provider Demographics
NPI:1063415834
Name:ADVANCED DIABETIC SERVICES
Entity type:Organization
Organization Name:ADVANCED DIABETIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SAALFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-4237
Mailing Address - Street 1:PO BOX 10327
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0000
Mailing Address - Country:US
Mailing Address - Phone:615-896-4237
Mailing Address - Fax:615-848-1026
Practice Address - Street 1:151 HERITAGE PARK DR
Practice Address - Street 2:STE 403
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0505
Practice Address - Country:US
Practice Address - Phone:615-896-4237
Practice Address - Fax:615-848-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1158950Medicaid
TN1454235Medicaid
WA9058850Medicaid
OH2403063Medicaid
CAXDME03007Medicaid
KY9000649500Medicaid
WA9058850Medicaid