Provider Demographics
NPI:1861710006
Name:DIVERSIFIED INDEPENDENT DIAGNOSTICS
Entity type:Organization
Organization Name:DIVERSIFIED INDEPENDENT DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-650-9500
Mailing Address - Street 1:1701 WEBSTER ST STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5800
Mailing Address - Country:US
Mailing Address - Phone:713-650-9500
Mailing Address - Fax:
Practice Address - Street 1:1701 WEBSTER ST STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5800
Practice Address - Country:US
Practice Address - Phone:713-650-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty