Provider Demographics
NPI:1467884239
Name:SETON MEDICAL GROUP
Entity Type:Organization
Organization Name:SETON MEDICAL GROUP
Other - Org Name:SETON DIABETES AND MEDICAL NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF DISEASE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYSABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-1000
Mailing Address - Street 1:5555 N LAMAR BLVD
Mailing Address - Street 2:STE D 125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1073
Mailing Address - Country:US
Mailing Address - Phone:512-324-1891
Mailing Address - Fax:512-324-1396
Practice Address - Street 1:5555 N LAMAR BLVD
Practice Address - Street 2:STE D-125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1034
Practice Address - Country:US
Practice Address - Phone:512-324-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETON MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-05
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319120YVTFMedicare PIN
TX318839YVTFMedicare PIN
TX319197YW22Medicare PIN
TX319034YW22Medicare PIN
TX368568YW22Medicare PIN