MEDICARE: DIAMOND DIAGNOSTICS

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	173F00000X	Sleep Specialist (PhD)	LC1047927	MO

General Provider Information

NPI Number	:	1073831921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND DIAGNOSTICS

Provider Business Mailing Address
First Line	:	PO BOX 577
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63702-0577
Country	:	US
Telephone Number	:	573-334-9095
Fax Number	:	573-334-0960

Provider Business Practice Location Address
First Line	:	3262 LEXINGTON AVE
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2609
Country	:	US
Telephone Number	:	573-334-9095
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LLOYD W DIAMOND
Credential	:
Telephone Number	:	573-334-9095

Provider Enumeration Date	:	05/16/2010
Last Update Date	:	07/07/2020

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Directions to “DIAMOND DIAGNOSTICS ” Practice Location

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