Healthcare Provider Details

I. General information

NPI: 1346635687
Provider Name (Legal Business Name): DIAMOND AIRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 B BUSINESS HWY 60 WEST
DEXTER MO
63841-2837
US

IV. Provider business mailing address

1638 B BUSINESS HWY 60 WEST
DEXTER MO
63841-2837
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-4995
  • Fax: 573-614-4057
Mailing address:
  • Phone: 573-614-4995
  • Fax: 573-614-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. ANGELA DAWN DELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-614-4995