Provider Demographics
NPI:1447944459
Name:TRUEBLUE MD DIABETIC SUPPLIES LLC
Entity type:Organization
Organization Name:TRUEBLUE MD DIABETIC SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-446-5168
Mailing Address - Street 1:21515 RIDGETOP CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6576
Mailing Address - Country:US
Mailing Address - Phone:855-822-9865
Mailing Address - Fax:
Practice Address - Street 1:21515 RIDGETOP CIR STE 120
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6576
Practice Address - Country:US
Practice Address - Phone:855-822-9865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies