Provider Demographics
NPI:1053344093
Name:DIABETES SELF-MANAGEMENT CENTER, INC.
Entity type:Organization
Organization Name:DIABETES SELF-MANAGEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOVEMBER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:P.O. BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:420 W PINHOOK RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2131
Practice Address - Country:US
Practice Address - Phone:337-232-1717
Practice Address - Fax:337-232-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC8672OtherBLUE CROSS BLUE SHIELD OF
LAC8672OtherBLUE CROSS BLUE SHIELD OF