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General NPI Number Information
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NPI Number | 1295035913
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Entity Type | Organization
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Legal Business Name | DIAMOND STAR MEDICAL LLC
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 1300 HAWKS CREST DR
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8407
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Country | US
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Telephone | 904-755-2367
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | MIDDLEBURG
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State | FL
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Zip | 32050-0331
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Country | US
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Telephone | 904-755-2367
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. BRENDA GAIL DAVIS
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Credential |
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Telephone | 904-755-2367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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