Ishimaru Medical Services LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ISHIMARU MEDICAL SERVICES LLC

Practice address

507 Carolina Ave
Chester, WV 26034-1319

Phone

(304) 224-3583

Fax

(304) 459-5050

NPI assigned

Apr 29, 2022

Organization subpart

No

Name

Richard Jack Diamond, CRNP

Title

Medical Director

Phone

(724) 851-5312

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 28, 2022.

{
    "created_epoch": "1651190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1487399887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 CAROLINA AVE",
            "city": "CHESTER",
            "state": "WV",
            "postal_code": "260341319",
            "telephone_number": "304-224-3583",
            "fax_number": "304-459-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 CAROLINA AVE",
            "city": "CHESTER",
            "state": "WV",
            "postal_code": "260341319",
            "telephone_number": "304-224-3583",
            "fax_number": "304-459-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISHIMARU MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JACK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "724-851-5312",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1700353539",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Gittings
• Leslie B Gough
• Harvest Healthcare Solutions LLC
• Brandi Headley
• Robyn Huffman
• James Thomas Karnoupakis, RPH
• Nancy Kifer-Reed
• Fred D Kinsey, D.D.S.
• Krzysztof J Kubicki, MD
• Krzysztof Kubicki, M.D.

• All providers in Chester, WV
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.