Provider Demographics
NPI:1699868380
Name:DIABETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:DIABETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-686-3600
Mailing Address - Street 1:P.O. BOX 1081
Mailing Address - Street 2:305 E MAIN ST
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565
Mailing Address - Country:US
Mailing Address - Phone:877-686-3600
Mailing Address - Fax:260-768-4111
Practice Address - Street 1:240 N MORTON ST
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565
Practice Address - Country:US
Practice Address - Phone:877-686-3600
Practice Address - Fax:260-768-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI874879620Medicaid
MI874879620Medicaid