Provider Demographics
NPI:1083367015
Name:NATIONAL DIABETES CARE, LLC.
Entity type:Organization
Organization Name:NATIONAL DIABETES CARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-621-6887
Mailing Address - Street 1:384 S INDUSTRIAL DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7405
Mailing Address - Country:US
Mailing Address - Phone:386-873-2911
Mailing Address - Fax:
Practice Address - Street 1:384 S INDUSTRIAL DR UNIT A
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7405
Practice Address - Country:US
Practice Address - Phone:386-873-2911
Practice Address - Fax:386-200-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies