Healthcare Provider Details

I. General information

NPI: 1528295581
Provider Name (Legal Business Name): DIVERSE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 BRIARWOOD RD LOT 99
MERIDIAN MS
39305-9105
US

IV. Provider business mailing address

383 BRIARWOOD RD LOT 99
MERIDIAN MS
39305-9105
US

V. Phone/Fax

Practice location:
  • Phone: 601-581-1420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMS

VIII. Authorized Official

Name: KATHLEEN SUDDUTH
Title or Position: MANAGER
Credential:
Phone: 601-479-4963