MEDICARE: DIVERSE MULTI BILLING 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1861039869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSE MULTI BILLING LLC

Provider Business Mailing Address
First Line	:	PO BOX 26086
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33320-6086
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3646 NW 29TH CT
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-8357
Country	:	US
Telephone Number	:	954-200-4682
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELENA DUROCHER
Credential	:
Telephone Number	:	954-200-4682

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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