Provider Demographics
NPI:1962552943
Name:DIAMOND MEDICAL EQUIPMENT L.L.C.
Entity type:Organization
Organization Name:DIAMOND MEDICAL EQUIPMENT L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FACTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-4363
Mailing Address - Street 1:1324 NORTH FARRELL COURT
Mailing Address - Street 2:102
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1945
Mailing Address - Country:US
Mailing Address - Phone:480-926-4363
Mailing Address - Fax:480-926-4364
Practice Address - Street 1:1324 NORTH FARRELL COURT
Practice Address - Street 2:102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1945
Practice Address - Country:US
Practice Address - Phone:480-926-4363
Practice Address - Fax:480-926-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZ20018536332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========001OtherBLUE CROSS BLUE SHIELD
AZ=========001OtherBLUE CROSS BLUE SHIELD