Provider Demographics
NPI:1992772081
Name:DIABETIC SUPPLY FOUNDATION OF 94 INC
Entity type:Organization
Organization Name:DIABETIC SUPPLY FOUNDATION OF 94 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-875-0733
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0976
Mailing Address - Country:US
Mailing Address - Phone:704-875-0733
Mailing Address - Fax:704-948-9704
Practice Address - Street 1:124A HUNTERSVILLE CONCORD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6215
Practice Address - Country:US
Practice Address - Phone:704-875-0733
Practice Address - Fax:704-948-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC77701560Medicaid
SCDM0661Medicaid
NC0463EOtherBCBLUE SHIELD PROVIDER ID
VA009113126Medicaid
NC0867180001Medicare NSC