Carmen C Clelland & Laura a Clelland

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1169830001 Issued in AZ

Legal business name

CARMEN C CLELLAND & LAURA A CLELLAND

Doing business as

DiabeteSource

Practice address

207 N Williamson Ave
Winslow, AZ 86047-3719

Phone

(928) 289-2778

Fax

(928) 289-6777

NPI assigned

Jul 10, 2006

Last updated

Jul 10, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laura A Clelland

Title

Owner

Phone

(928) 289-2778

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DiabeteSource Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1306870043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N WILLIAMSON AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473719",
            "telephone_number": "928-289-2778",
            "fax_number": "928-289-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N WILLIAMSON AVE",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473719",
            "telephone_number": "928-289-2778",
            "fax_number": "928-289-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARMEN C CLELLAND & LAURA A CLELLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "CLELLAND",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-289-2778"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "1169830001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429771",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DiabeteSource",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian A Bucina, D.O.
• Susan Helen Bumpus, MSN, RN
• Gavin Barry Butler, MD
• Charlotte Bynar
• Jenae Cantrell
• Changepoint Integrated Health
• Jennie Chester
• Melody Chou, DMD
• Sharon Christian, RN
• Carmen Cirilo Clelland, PHARM.D.

• Durable Medical Equipment & Medical Supplies in Winslow, AZ
• Providers in Winslow, AZ by specialty
• Durable Medical Equipment & Medical Supplies in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.