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NPI Code Detail

MEDICARE: CASSIDY DIEDE AA

MEDICARE: CASSIDY DIEDE AA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367H00000XAnesthesiologist Assistant32698256TX

General Provider Information

NPI Number : 1003535733
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY DIEDE AA
Provider Business Mailing Address
First Line : PO BOX 764
Second Line :
City : MEAD
State : CO
Zip : 80542-0764
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 602 INDIANA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79415-3364
Country : US
Telephone Number : 806-743-2891
Fax Number : 806-743-2984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2022
Last Update Date : 03/05/2026

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Directions to “ CASSIDY DIEDE AA” Practice Location

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