Provider Demographics
NPI:1295163723
Name:DIAMEDIX HEALTHCARE, LLC.
Entity type:Organization
Organization Name:DIAMEDIX HEALTHCARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TADIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-747-8900
Mailing Address - Street 1:4860 COX ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:317-755-0318
Mailing Address - Fax:804-747-8910
Practice Address - Street 1:5455 W. 86TH STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1530
Practice Address - Country:US
Practice Address - Phone:317-755-0318
Practice Address - Fax:804-747-8910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAMEDIX HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5032200001Medicare NSC