NPIMap

Organization Active NPI

Diabetes Store, Incorporated

Doing business as Diabetes Store, Inc.

  • Prosthetic/Orthotic Supplier
  • Memphis, TN
National Provider Identifier
1740875400
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
DIABETES STORE, INCORPORATED
Doing business as
Diabetes Store, Inc.
Practice address
1760 Moriah Woods Blvd Ste 2
Memphis, TN 38117-7128
Phone
(901) 312-3150
Fax
(800) 208-0863
NPI assigned
Mar 4, 2021
Last updated
Nov 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Authorized official

Name
Craig Brosseau
Title
Secretary
Phone
(952) 646-3255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

1760 Moriah Woods Blvd Ste 2
Memphis, TN 38117-7128

Mailing address

1760 Moriah Woods Blvd Ste 2
Memphis, TN 38117-7128
Phone (901) 312-3150

Other names 1

  • Diabetes Store, Inc. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Diabetes Store Incorporated4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1740875400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 MORIAH WOODS BLVD STE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381177128",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 MORIAH WOODS BLVD STE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381177128",
            "telephone_number": "901-312-3150",
            "fax_number": "800-208-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES STORE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "BROSSEAU",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-646-3255"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Store, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Diabetes Store, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; 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.