Provider Demographics
NPI:1568473882
Name:DIABETEX OF TEXAS, LLC.
Entity Type:Organization
Organization Name:DIABETEX OF TEXAS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-625-2200
Mailing Address - Street 1:1222 N MAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5712
Mailing Address - Country:US
Mailing Address - Phone:210-281-9400
Mailing Address - Fax:210-281-9716
Practice Address - Street 1:1222 N MAIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5712
Practice Address - Country:US
Practice Address - Phone:210-281-9400
Practice Address - Fax:210-281-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1229030001Medicare NSC