Organization
ISHIMARU MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD JACK DIAMOND CRNP (MEDICAL DIRECTOR)
(724) 851-5312
Entity
Organization
Contact information
Practice address
507 CAROLINA AVE, CHESTER, WV 26034-1319
(304) 224-3583
(304) 459-5050
Mailing address
507 CAROLINA AVE, CHESTER, WV 26034-1319
(304) 224-3583
(304) 459-5050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700353539
NPI
—
Enumeration date
04/29/2022
Last updated
09/28/2022
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