NPIMap

Organization Active NPI

Pre Diabetes Physician Services Inc

  • Specialist
  • Fort Worth, TX
National Provider Identifier
1639581077
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
L4258 Issued in TX
Legal business name
PRE DIABETES PHYSICIAN SERVICES INC
Practice address
1307 8TH Ave Ste 502
Fort Worth, TX 76104-4137
Phone
(512) 623-4900
NPI assigned
May 20, 2014
Last updated
May 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Randy Marfin
Title
Ceo
Phone
(512) 623-4919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X L4258 TX Primary

Addresses

Primary practice location

1307 8TH Ave Ste 502
Fort Worth, TX 76104-4137

Mailing address

3721 Executive Center Dr
Austin, TX 78731-1645
Phone (512) 623-4900

National Provider Directory

National Provider Directory
Tax ID family
Pre Diabetes Physician Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3721 Executive Center Dr
Austin, TX 78731
Phone (512) 372-3777

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1639581077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 EXECUTIVE CENTER DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311645",
            "telephone_number": "512-623-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 8TH AVE STE 502",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044137",
            "telephone_number": "512-623-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRE DIABETES PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-20",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "MARFIN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-623-4919"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "L4258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.