Provider Demographics
NPI:1760721666
Name:DIAPER MAN LLC
Entity Type:Organization
Organization Name:DIAPER MAN LLC
Other - Org Name:THE DIAPER MAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-392-9696
Mailing Address - Street 1:400 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-3619
Mailing Address - Country:US
Mailing Address - Phone:662-392-9696
Mailing Address - Fax:
Practice Address - Street 1:400 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-3619
Practice Address - Country:US
Practice Address - Phone:662-392-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871365332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies