1780856187 NPI number — M. HASSAN DIAB, M.D., S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780856187 NPI number — M. HASSAN DIAB, M.D., S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M. HASSAN DIAB, M.D., S.C.
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:
Provider Other Organization Name Type Code:
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:
1780856187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2560 24TH ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ROCK ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61201-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-7491
Provider Business Mailing Address Fax Number:
309-779-3093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2560 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-7491
Provider Business Practice Location Address Fax Number:
309-779-3093
Provider Enumeration Date:
03/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIAB
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
HASSAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
309-779-7491

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  3651347 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1155524 . This is a "MULTIPLANS NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207R00000X . This is a "TAXONOMY CODE INT MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171903 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008100288 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 085055 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15460 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207RH0003X . This is a "TAXONOMY CODE HEM/ONCOLOG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0984328 . This is a "IOWA MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IL0101 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98553 . This is a "WELLMARK BC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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