1265568596 NPI number — DIA-TECH SERVICES LLC

Table of content: (NPI 1265568596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265568596 NPI number — DIA-TECH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIA-TECH SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIA-TECH SERVICES LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265568596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3923 WINNEBAGO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70805-5958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-266-6812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3923 WINNEBAGO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805-5958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-266-6812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
LIZZSET
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-266-6812

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 223948168 . This is a "LACARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "AETNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "TRICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "OFFICE OF RISK MANAGEMENT" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "LOUISIANA HEALTHCARE CONNECTIONS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: H7520 . This is a "BLUECROSS/BLUESHIELD OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 223948168 . This is a "AMERIGROUP COMMUNITY CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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