Provider Demographics
NPI:1336470889
Name:DIAMOND CONSULTING CORPORATION
Entity Type:Organization
Organization Name:DIAMOND CONSULTING CORPORATION
Other - Org Name:ASSOCIATES AT THE PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:804-649-9340
Mailing Address - Street 1:701 E BYRD ST
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3921
Mailing Address - Country:US
Mailing Address - Phone:804-649-9340
Mailing Address - Fax:804-782-2286
Practice Address - Street 1:5483 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:434-791-2059
Practice Address - Fax:434-791-2835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAMOND HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-22
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C11029Medicare Oscar/Certification