Provider Demographics
NPI:1376735951
Name:DIAMOND MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:DIAMOND MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:317-291-1211
Mailing Address - Street 1:6865 PARKDALE PL STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5655
Mailing Address - Country:US
Mailing Address - Phone:317-291-1211
Mailing Address - Fax:317-291-1194
Practice Address - Street 1:6865 PARKDALE PL STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5655
Practice Address - Country:US
Practice Address - Phone:317-291-1211
Practice Address - Fax:317-291-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060259A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233760Medicare PIN
IN233760BMedicare PIN
IN233760AMedicare PIN