Provider Demographics
NPI:1194424150
Name:DIAMOND DME UT, LLC
Entity type:Organization
Organization Name:DIAMOND DME UT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HILLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:702-219-7126
Mailing Address - Street 1:1490 E FOREMASTER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4532
Mailing Address - Country:US
Mailing Address - Phone:435-319-8330
Mailing Address - Fax:855-740-1560
Practice Address - Street 1:1490 E FOREMASTER DR STE 140
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4532
Practice Address - Country:US
Practice Address - Phone:435-319-8330
Practice Address - Fax:855-740-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies