302 Body Shop

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

302 BODY SHOP

Practice address

4601 South Dupont Highway
St 1
Dover, DE 19901

Phone

(302) 698-1100

NPI assigned

Sep 5, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronnie Diem, PA-C

Title

Owner

Phone

(302) 331-9026

Specialties & licenses 1

Addresses

Tax ID family

302 Body Shop2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 302 Body Shop

  • Clinic/Center
  • Dover, DE
  • NPI 1790468353
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1811773906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 SOUTH DUPONT HIGHWAY",
            "address_2": "ST 1",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "19901",
            "telephone_number": "302-331-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 SOUTH DUPONT HIGHWAY",
            "address_2": "ST 1",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "19901",
            "telephone_number": "302-698-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "302 BODY SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-05",
        "last_updated": "2023-09-05",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "DIEM",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-331-9026",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• .Alfred B. Lauder, D.D.S.
• 1080 Silver Lake Boulevard Operations LLC (Silver Lake Center)
• 1203 Walker Road Operations LLC (Heritage at Dover)
• 302 Body Shop
• A Better Mindset Mental Health LLC
• A Center for Human Development LTD
• A Center for Mental Wellness Community Support Program (Child and Family Outpatient Services in Sussex at ACFMW)
• A Center for Mental Wellness Community Support Programs, LLC (Chrysalis for Youth in Kent at ACFMW)
• A Center for Mental Wellness Community Support Programs, LLC (A Center for Mental Wellness Community Support Programs)

• Multi-Specialty Clinic/Center in Dover, DE
• Providers in Dover, DE by specialty
• Multi-Specialty Clinic/Center in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.