Organization
DIAMOND MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD MOUSE D.O. (PHYSICIAN)
(816) 295-1606
Entity
Organization
Contact information
Practice address
1101 NW PAMELA BLVD, SUITE A, GRAIN VALLEY, MO 64029-7841
(816) 295-1606
Mailing address
1101 NW PAMELA BLVD, SUITE A, GRAIN VALLEY, MO 64029-7841
(816) 295-1606
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R9G82
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588604979
—
MO
Enumeration date
03/31/2015
Last updated
03/31/2015
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