1891803433 NPI number — DIVERSIFIED MANAGEMENT SERVICES LLC

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 1891803433 NPI number — DIVERSIFIED MANAGEMENT SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSIFIED MANAGEMENT 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:
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:
1891803433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-872-6722
Provider Business Mailing Address Fax Number:
813-872-6341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10817 BLOOMINGDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERVIEW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-662-5437
Provider Business Practice Location Address Fax Number:
813-655-3025
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
ARNALDO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-872-6722

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B903K . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 292111 . This is a "AO MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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