NPIMap

Organization Active NPI

Dimitrios Mantzoros

  • Durable Medical Equipment & Medical Supplies
  • Conroe, TX
National Provider Identifier
1154571883
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1068 Issued in TX
Legal business name
DIMITRIOS MANTZOROS
Practice address
100 Medical Center Blvd
Ste 216
Conroe, TX 77304-2888
Phone
(936) 756-9191
NPI assigned
Sep 30, 2008
Last updated
Apr 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dimitrios Mantzoros, D.P.M.NPI 1285660803
Title
Physician
Phone
(936) 756-9191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1068 TX Primary

Addresses

Primary practice location

100 Medical Center Blvd
Ste 216
Conroe, TX 77304-2888

Mailing address

100 Medical Center Blvd
Ste 216
Conroe, TX 77304-2888
Phone (936) 756-9191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930071222 TX DME Supplier - Physician - Podiatry 5698894194 1 other NPI on this enrollment
Practice locations: Conroe, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1020 Riverwood Ct
Ste 220
Conroe, TX 77304
Phone (936) 756-9191

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1154571883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER BLVD",
            "address_2": "STE 216",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042888",
            "telephone_number": "936-756-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER BLVD",
            "address_2": "STE 216",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042888",
            "telephone_number": "936-756-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRIOS MANTZOROS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "MANTZOROS",
        "authorized_official_first_name": "DIMITRIOS",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "936-756-9191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "1068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.