1912699240 NPI number — TRUE DIABETES NEUROPATHY & WOUND SOLUTIONS AZ LLC

Table of content: (NPI 1912699240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912699240 NPI number — TRUE DIABETES NEUROPATHY & WOUND SOLUTIONS AZ LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUE DIABETES NEUROPATHY & WOUND SOLUTIONS AZ LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912699240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5171 S CUB LAKE RD STE C330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOW LOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85901-7997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-243-0348
Provider Business Mailing Address Fax Number:
480-977-1138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5171 S CUB LAKE RD STE C330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOW LOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85901-7997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-243-0348
Provider Business Practice Location Address Fax Number:
928-328-1288
Provider Enumeration Date:
05/24/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF INFORMATION OFFICER
Authorized Official Telephone Number:
480-740-1910

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366183212 . This is a "NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1598314247 . This is a "NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".