Provider Demographics
NPI:1760589782
Name:DIABETES & ENDOCRINE CENTER OF CENTRAL TEXAS PA
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINE CENTER OF CENTRAL TEXAS PA
Other - Org Name:DIABETES & ENDOCRINE CENTER OF CENTRAL TEXAS PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-751-9777
Mailing Address - Street 1:333 LONDONDERRY DR
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7900
Mailing Address - Country:US
Mailing Address - Phone:254-751-9777
Mailing Address - Fax:254-751-9788
Practice Address - Street 1:333 LONDONDERRY DR
Practice Address - Street 2:SUITE # 200
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7900
Practice Address - Country:US
Practice Address - Phone:254-751-9777
Practice Address - Fax:254-751-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2630207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0086EHOtherBCBS
TX45D0704873OtherCLIA DIABETES & ENDOCRINE
TX081085501Medicaid
CH8030OtherRAILROAD MEDICARE
TX45D0704873OtherCLIA DIABETES & ENDOCRINE