Provider Demographics
NPI:1558391730
Name:DEL RIO TEXAS HEART INSTITUTE & DIABETES CENTER PA
Entity Type:Organization
Organization Name:DEL RIO TEXAS HEART INSTITUTE & DIABETES CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DI BLASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-703-8555
Mailing Address - Street 1:3809 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2860
Mailing Address - Country:US
Mailing Address - Phone:830-703-8555
Mailing Address - Fax:830-703-8334
Practice Address - Street 1:3809 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2860
Practice Address - Country:US
Practice Address - Phone:830-703-8555
Practice Address - Fax:830-703-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7944207RC0000X
TXL7952207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9390OtherBLUE CROSS BLUE SHIELD
TXP00194362OtherRRMER
TX8K9391OtherBLUE CROSS BLUE SHIELD
TX171252301Medicaid
TX171255601Medicaid
TXG17374Medicare UPIN
TXP00194362OtherRRMER
TX8K9391OtherBLUE CROSS BLUE SHIELD
TX171252301Medicaid