Provider Demographics
NPI:1063758399
Name:DIAMOND MEDICAL URGENT CARE, LLC
Entity type:Organization
Organization Name:DIAMOND MEDICAL URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-223-0032
Mailing Address - Street 1:144 VALHI LAGOON XING
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3208
Mailing Address - Country:US
Mailing Address - Phone:985-223-0032
Mailing Address - Fax:985-872-6670
Practice Address - Street 1:144 VALHI LAGOON XING
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3208
Practice Address - Country:US
Practice Address - Phone:985-223-0032
Practice Address - Fax:985-872-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care