Diabetic Shoe Source

LBN: Diabetic Shoe Source
Diabetic Shoe Source is an health care organization with primary practice located at 2121 Cliff Dr Ste 118 , Eagan MN 55122-3431. The organization recently has only one registered license in Suppliers / Durable Medical Equipment & Medical Supplies, which is considered as the primary health care specialty. Diabetic Shoe Source can be contacted via phone (763) 757-8086, or through Luzaich, Amy via phone (763) 757-8086.

Contact Information

Primary practice address
2121 Cliff Dr Ste 118 Eagan MN 55122-3431
Phone: (763) 757-8086
Fax: (763) 862-4797
Website:
Map and Directions
Authorized official contact:
Name: Luzaich, Amy CFTS
Phone: (763) 757-8086

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X

Profile Details

NPI number 1003960147
LBN Legal business name Diabetic Shoe Source
DBA Doing business as
Authorized official Luzaich, Amy CFTS
Entity Organization
Organization subpart 1 No
Enumeration date Jan 23rd, 2007
Last updated Oct 21st, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003960147 NPPES
Minnesota Other 786A6DI BCBS
Minnesota MEDICAID 520052200 BCBS

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