NPIMap

Organization Active NPI

Diana L. Gillmore, M.D.,L.L.C.

  • Surgery Physician
  • Slidell, LA
National Provider Identifier
1851679849
Registry record updated Jul 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
05478R Issued in LA
Legal business name
DIANA L. GILLMORE, M.D.,L.L.C.
Practice address
985 Robert Blvd
Suite 103
Slidell, LA 70458-2063
Phone
(985) 646-1884
Fax
(985) 646-1885
NPI assigned
Jul 26, 2011
Last updated
Jul 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2011

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

Authorized official

Name
Dr. Diana Lee Gillmore, M.D.NPI 1437147352
Title
Owner/Surgeon
Phone
(985) 646-1884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 05478R LA Primary

Addresses

Primary practice location

985 Robert Blvd
Suite 103
Slidell, LA 70458-2063

Mailing address

985 Robert Blvd
Suite 103
Slidell, LA 70458-2063
Phone (985) 646-1884

Other identifiers 3

IdentifierTypeStateIssuer
1363367MedicaidLA
39700OtherLABLUE CROSS BLUE SHIELD
0015875MedicaidMS

National Provider Directory

National Provider Directory

Locations

985 Robert Blvd
Ste 104
Slidell, LA 70458
Phone (985) 520-0909

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311638400000",
    "number": "1851679849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 ROBERT BLVD",
            "address_2": "SUITE 103",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582063",
            "telephone_number": "985-646-1884",
            "fax_number": "985-646-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 ROBERT BLVD",
            "address_2": "SUITE 103",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582063",
            "telephone_number": "985-646-1884",
            "fax_number": "985-646-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANA L. GILLMORE, M.D.,L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2011-07-26",
        "status": "A",
        "authorized_official_last_name": "GILLMORE",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/SURGEON",
        "authorized_official_telephone_number": "985-646-1884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "05478R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1363367",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "39700",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015875",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; 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.