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

Table of content: (NPI 1780856187)

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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