Healthcare Provider Details

I. General information

NPI: 1962552943
Provider Name (Legal Business Name): DIAMOND MEDICAL EQUIPMENT L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 NORTH FARRELL COURT 102
GILBERT AZ
85233-1945
US

IV. Provider business mailing address

1324 NORTH FARRELL COURT 102
GILBERT AZ
85233-1945
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-4363
  • Fax: 480-926-4364
Mailing address:
  • Phone: 480-926-4363
  • Fax: 480-926-4364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number20018536
License Number StateAZ

VIII. Authorized Official

Name: MIKE FACTOR
Title or Position: C.E.O.
Credential:
Phone: 480-926-4363