Provider Demographics
NPI:1922346329
Name:DIAMOND CLEAR DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:DIAMOND CLEAR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:THREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-850-0202
Mailing Address - Street 1:5100 TALLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8032
Mailing Address - Country:US
Mailing Address - Phone:501-850-0202
Mailing Address - Fax:501-850-0211
Practice Address - Street 1:5100 TALLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8032
Practice Address - Country:US
Practice Address - Phone:501-850-0202
Practice Address - Fax:501-850-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARBL149032291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory