Provider Demographics
NPI:1821413402
Name:BLUEBONNET HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BLUEBONNET HEALTH CENTER LLC
Other - Org Name:DIABETIC AND NEUROPATHY CENTERS OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHYRISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-447-4990
Mailing Address - Street 1:2000 FRONTIER STE 250
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5942
Mailing Address - Country:US
Mailing Address - Phone:713-447-4990
Mailing Address - Fax:
Practice Address - Street 1:2000 FRONTIER
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-5942
Practice Address - Country:US
Practice Address - Phone:713-447-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty