MEDICARE: DIAMOND CANYON MEDICAL SUPPILES LLC.

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053621383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND CANYON MEDICAL SUPPILES LLC.

Provider Business Mailing Address
First Line	:	7625 E CAMELBACK RD
Second Line	:	UNIT 250A
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2105
Country	:	US
Telephone Number	:	734-560-1406
Fax Number	:	734-335-7570

Provider Business Practice Location Address
First Line	:	7625 E CAMELBACK RD
Second Line	:	UNIT 250A
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2105
Country	:	US
Telephone Number	:	734-560-1406
Fax Number	:	734-335-7570

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	BHUPINDERJIT KAUR NIJJAR
Credential	:
Telephone Number	:	734-560-1406

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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