Provider Demographics
NPI:1598914293
Name:DIAMOND MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:DIAMOND MEDICAL SUPPLY, LLC
Other - Org Name:TONY JUNIOUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-696-4206
Mailing Address - Street 1:230 W BOYCE ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3020
Mailing Address - Country:US
Mailing Address - Phone:803-696-4206
Mailing Address - Fax:803-696-4206
Practice Address - Street 1:230 W BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3020
Practice Address - Country:US
Practice Address - Phone:803-696-4206
Practice Address - Fax:803-696-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies