Provider Demographics
NPI:1407886724
Name:DIVERSIFIED MEDICAL SPECIALTIES INC
Entity Type:Organization
Organization Name:DIVERSIFIED MEDICAL SPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-345-8858
Mailing Address - Street 1:961 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2805
Mailing Address - Country:US
Mailing Address - Phone:205-345-8858
Mailing Address - Fax:205-345-7991
Practice Address - Street 1:961 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2805
Practice Address - Country:US
Practice Address - Phone:205-345-8858
Practice Address - Fax:205-345-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL630014349332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009509590Medicaid
AL0938170001Medicare NSC