Healthcare Provider Details

I. General information

NPI: 1427718121
Provider Name (Legal Business Name): DIAMOND INTERVENTIONAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NE RALPH POWELL RD STE A
LEES SUMMIT MO
64064-2369
US

IV. Provider business mailing address

14109 OVERBROOK RD STE A
LEAWOOD KS
66224-4519
US

V. Phone/Fax

Practice location:
  • Phone: 816-721-4968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVEN ROY
Title or Position: MANAGING PARTNER
Credential:
Phone: 209-756-4832