Healthcare Provider Details

I. General information

NPI: 1396744694
Provider Name (Legal Business Name): DIAMEDIX HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 COX RD SUITE 300
GLEN ALLEN VA
23060-9250
US

IV. Provider business mailing address

4860 COX RD SUITE 300
GLEN ALLEN VA
23060-9250
US

V. Phone/Fax

Practice location:
  • Phone: 804-747-8900
  • Fax: 804-747-8910
Mailing address:
  • Phone: 804-747-8900
  • Fax: 804-747-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD07211000
License Number StateVA

VIII. Authorized Official

Name: TAMARA L EISELE
Title or Position: EXECUTIVE VICE PRESIDENT/COO
Credential:
Phone: 804-747-8900