Provider Demographics
NPI:1851409783
Name:CHOICE DIABETIC SUPPLY, INC.
Entity type:Organization
Organization Name:CHOICE DIABETIC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-875-6132
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1256
Mailing Address - Country:US
Mailing Address - Phone:704-875-6132
Mailing Address - Fax:704-875-6147
Practice Address - Street 1:103 SOUTH OLD STATESVILLE ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-875-6132
Practice Address - Fax:704-875-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0868400001Medicare ID - Type UnspecifiedMEDICARE ID