DIABETIC RENEWAL CENTER LLC (NPI# 1750764189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750764189 |
| Entity Type | Organization |
| Organization Name | DIABETIC RENEWAL CENTER LLC |
| Other Organization Name | TRINA HEALTH CARE CENTER OF TYLER LLC |
| Practice Address |
1015 Pruitt Pl Ste 105 Tyler TX 75703-1154 |
| Practice Telephone | 9035286000 |
| Practice Fax Number | 9035260565 |
| Mailing Telephone | (903) 258-6000 |
| Mailing Fax Number | 9035260565 |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | JEFF E DETHLEFSEN (OWNER) |
| Authorized Official Telephone | 9032586000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | F3205 | TX | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
261Q10500X | TX | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| TRINA HEALTH CARE CENTER OF TYLER LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1108 S Buffalo St, Canton, TX 751032304 | 9032586000 | 9035260565 |
| Street Address |
1015 PRUITT PL STE 105 |
| City | TYLER |
| State | TX |
| Zip Code | 75703-1154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 261QI0500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Infusion Therapy |
| Definition to come... |
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| 1467084376 | Advanced Tms Neuro Therapeutics, LLC | Clinic/Center | 7100 Westwind Dr Ste 300b, El Paso, TX 79912-1743 | 2020-02-08 |
| 1578108254 | Carissa Arielle Ainsworth | Clinic/Center | 7700 Main St Ste 210, Houston, TX 77030-4457 | 2019-11-17 |
| 1194368605 | Advanced Infusion Services, LLC | Clinic/Center | 1901 Medi Park Dr Ste 1057, Amarillo, TX 79106-2168 | 2019-10-28 |
| 1487217766 | Pro Med Infusion LLC | Clinic/Center | 13134 Dairy Ashford Rd Ste 900b, Sugar Land, TX 77478-3756 | 2019-04-22 |
| 1871060251 | Diabetes Relief Houston Southwest LLC | Clinic/Center | 8200 Wednesbury Ln Ste 390, Houston, TX 77074-2999 | 2018-10-24 |
| 1316412109 | Ais Bs LLC | Clinic/Center | 6671 Southwest Fwy Ste 300m, Houston, TX 77074-2212 | 2018-10-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.