Organization · Type 2 NPI

Diabetic Renewal Center LLC

Infusion Therapy Clinic/Center · Tyler, TX

NPI number 1750764189 Active

Practice location

1015 Pruitt Pl Ste 105
Tyler, TX 75703-1154

Call (903) 528-6000 Map

Fax (903) 526-0565

Other practice locations

1108 S Buffalo St, Canton, TX 75103-2304 · (903) 258-6000

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician	207Q00000X	None listed
Family Medicine Physician	207Q00000X	F3205 (TX)
Internal Medicine Physician	207R00000X	None listed
Infusion Therapy Clinic/Center Primary	261QI0500X	261Q10500X (TX)

Infusion Therapy Clinic/Center: Definition to come...

Other infusion therapy clinic/center providers in Tyler

MPP Infusion Center of Tyler LLCInfusion Therapy Clinic/Center Tyler, TX NPI 1952812109

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NPI record

NPI: 1750764189
Entity type: Organization (Type 2)
Issued: Jul 2, 2015
Last updated: Jul 21, 2022
Status: Active

Other names

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Trina Health Care Center of Tyler LLC · former legal business name
Trina Health Care Center of Tyler LLC · former legal business name

Authorized official

Jeff E Dethlefsen
Owner
(903) 258-6000

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1750764189

Diabetic Renewal Center LLC's National Provider Identifier is 1750764189, issued on Jul 2, 2015. The primary taxonomy on file is Infusion Therapy Clinic/Center (261QI0500X), and the practice location is in Tyler, TX. The record was last updated on Jul 21, 2022.