Provider Demographics
NPI:1124043963
Name:HEALTH SERVICES DIVERSIFIED, INC.
Entity Type:Organization
Organization Name:HEALTH SERVICES DIVERSIFIED, INC.
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:C
Authorized Official - Last Name:SILVIO
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:251-929-1017
Mailing Address - Street 1:104 ECOR ROUGE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3062
Mailing Address - Country:US
Mailing Address - Phone:251-929-1017
Mailing Address - Fax:251-929-1018
Practice Address - Street 1:104 ECOR ROUGE PL
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3062
Practice Address - Country:US
Practice Address - Phone:251-929-1017
Practice Address - Fax:251-929-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111749332B00000X, 332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003187Medicaid
AL009938825Medicaid
=========002OtherTRICARE CSP
AL100003187Medicaid
AL870023645Medicare PIN
AL1326480001Medicare NSC
=========002OtherTRICARE CSP