Provider Demographics
NPI:1417108960
Name:ASP CENTERS FOR DIABETIC MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ASP CENTERS FOR DIABETIC MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-298-6665
Mailing Address - Street 1:3040 POST OAK BLVD
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6500
Mailing Address - Country:US
Mailing Address - Phone:713-554-7500
Mailing Address - Fax:713-554-7510
Practice Address - Street 1:116 MEDICAL PARK LN
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4978
Practice Address - Country:US
Practice Address - Phone:713-554-7500
Practice Address - Fax:713-554-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service