MEDICARE: DIAMEDIX HEALTHCARE 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
2	332B00000X	Durable Medical Equipment & Medical Supplies	D07211000	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396744694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMEDIX HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	4860 COX RD
Second Line	:	SUITE 300
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-9250
Country	:	US
Telephone Number	:	804-747-8900
Fax Number	:	804-747-8910

Provider Business Practice Location Address
First Line	:	4860 COX RD
Second Line	:	SUITE 300
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-9250
Country	:	US
Telephone Number	:	804-747-8900
Fax Number	:	804-747-8910

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT/COO
Name	:	TAMARA L EISELE
Credential	:
Telephone Number	:	804-747-8900

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/11/2013

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