Provider Demographics
NPI:1457577413
Name:DIVERSIFIED MULTICULTURAL HEALTHCARE RESEARCH SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED MULTICULTURAL HEALTHCARE RESEARCH SERVICES, INC.
Other - Org Name:DIVERSIFIED RESEARCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-471-5474
Mailing Address - Street 1:116 CRUTCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2722
Mailing Address - Country:US
Mailing Address - Phone:919-471-5474
Mailing Address - Fax:919-471-5475
Practice Address - Street 1:116 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2722
Practice Address - Country:US
Practice Address - Phone:919-471-5474
Practice Address - Fax:919-471-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019YJOtherBLUE CROSS BLUE SHIELD OF NC
NC5909109Medicaid