Provider Demographics
NPI:1013045806
Name:DIVERSIFIED MEDICAL DISTRIBUTION INC.
Entity Type:Organization
Organization Name:DIVERSIFIED MEDICAL DISTRIBUTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTINEHAD
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:800-348-6337
Mailing Address - Street 1:3035 E PATRICK LN
Mailing Address - Street 2:STE # 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4930
Mailing Address - Country:US
Mailing Address - Phone:866-660-0567
Mailing Address - Fax:866-425-6020
Practice Address - Street 1:3035 E PATRICK LN
Practice Address - Street 2:STE # 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4930
Practice Address - Country:US
Practice Address - Phone:866-660-0567
Practice Address - Fax:866-425-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00275332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV192495OtherSTATE OF NV BUSINESS LIC
37533OtherACCREDITATION COMMISSION FOR HEALTH CARE, INC.
NV5298160001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #