Healthcare Provider Details

I. General information

NPI: 1720006232
Provider Name (Legal Business Name): DIVERSIFIED INFUSIONCARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 HIGHWAY 12 W SUITE E
STARKVILLE MS
39759-3593
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 662-320-9696
  • Fax: 662-320-9616
Mailing address:
  • Phone: 800-447-4095
  • Fax: 601-482-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number04633/02.1
License Number StateMS

VIII. Authorized Official

Name: STAN HAMILTON
Title or Position: PRESIDENT
Credential:
Phone: 662-320-9696