Provider Demographics
NPI:1316198096
Name:DIABETES-HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIABETES-HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-635-8007
Mailing Address - Street 1:255 BALD KNOB RD
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-6603
Mailing Address - Country:US
Mailing Address - Phone:731-635-8007
Mailing Address - Fax:
Practice Address - Street 1:255 BALD KNOB RD
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-6603
Practice Address - Country:US
Practice Address - Phone:731-635-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6334750001Medicare NSC