Provider Demographics
NPI:1225073695
Name:DIVERSIFIED HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-1799
Mailing Address - Street 1:PO BOX 2371
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-2371
Mailing Address - Country:US
Mailing Address - Phone:662-324-1799
Mailing Address - Fax:662-323-5719
Practice Address - Street 1:403 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2164
Practice Address - Country:US
Practice Address - Phone:662-324-1799
Practice Address - Fax:662-323-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02369/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040247Medicaid
MS0414650001Medicare ID - Type Unspecified