Provider Demographics
NPI:1003360785
Name:DIAGNOSTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-4263
Mailing Address - Street 1:3931 N STOCKTON HILL RD
Mailing Address - Street 2:STE E
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2426
Mailing Address - Country:US
Mailing Address - Phone:928-753-6020
Mailing Address - Fax:
Practice Address - Street 1:3931 N STOCKTON HILL RD
Practice Address - Street 2:STE E
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2426
Practice Address - Country:US
Practice Address - Phone:973-477-7923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL21125467291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ261318Medicaid