| Diamond Medical Care Llc | |
|
1101 Nw Pamela Blvd Suite A Grain Valley MO 64029-7841 | |
| (816) 295-1606 | |
| Not Available |
| Full Name | Diamond Medical Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1101 Nw Pamela Blvd, Grain Valley, Missouri |
| Authorized Official Name and Position | Brad Mouse (PHYSICIAN) |
| Authorized Official Contact | 8162951606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Medical Care Llc 1101 Nw Pamela Blvd Suite A Grain Valley MO 64029-7841 Ph: (816) 295-1606 | Diamond Medical Care Llc 1101 Nw Pamela Blvd Suite A Grain Valley MO 64029-7841 Ph: (816) 295-1606 |
| NPI Number | 1770978413 |
|---|---|
| Provider Enumeration Date | 03/31/2015 |
| Last Update Date | 03/31/2015 |
| Medicare PECOS PAC ID | 9739493081 |
|---|---|
| Medicare Enrollment ID | O20150731014643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770978413 | NPI | - | NPPES |
| 1588604979 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R9G82 (Missouri) | Primary |
| Provider Name | Brad A Mouse |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588604979 PECOS PAC ID: 6901951524 Enrollment ID: I20090903000556 |
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