1396744694 NPI number — DIAMEDIX HEALTHCARE LLC

Table of content: (NPI 1396744694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396744694 NPI number — DIAMEDIX HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAMEDIX HEALTHCARE 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:
Provider Other Organization Name Type Code:
6
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:
1396744694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4860 COX RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-9250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-747-8900
Provider Business Mailing Address Fax Number:
804-747-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4860 COX RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060-9250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-747-8900
Provider Business Practice Location Address Fax Number:
804-747-8910
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EISELE
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT/COO
Authorized Official Telephone Number:
804-747-8900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: D07211000 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DM1363 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com