Diabetic Renewal Center LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

License

261Q10500X Issued in TX

Legal business name

DIABETIC RENEWAL CENTER LLC

Practice address

1015 Pruitt PL Ste 105
Tyler, TX 75703-1154

Phone

(903) 528-6000

Fax

(903) 526-0565

NPI assigned

Jul 2, 2015

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeff E Dethlefsen

Title

Owner

Phone

(903) 258-6000

Specialties & licenses 4

Addresses

Other names 1

• TRINA HEALTH CARE CENTER OF TYLER LLC Former legal business name

Locations

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750764189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 PRUITT PL STE 105",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031154",
            "telephone_number": "903-258-6000",
            "fax_number": "903-526-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 PRUITT PL STE 105",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031154",
            "telephone_number": "903-528-6000",
            "fax_number": "903-526-0565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1108 S Buffalo St",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "TX",
            "postal_code": "751032304",
            "country_code": "US",
            "telephone_number": "903-258-6000",
            "fax_number": "903-526-0565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIABETIC RENEWAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DETHLEFSEN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-258-6000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F3205",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "TX",
            "license": "261Q10500X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRINA HEALTH CARE CENTER OF TYLER LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "TRINA HEALTH CARE CENTER OF TYLER LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cara L Dewolfe, CRNA
• Ernest L Dews Jr.
• Narpinder Singh Dhanoa, M.D.
• Amanpreet Dhillon, MD
• Raman Dhillon, MD
• Dialysis Access Surgery Center, LLC.
• Gabriel Dianes, MD
• Ana Carla Diaz-Carreno, LPC
• Christopher David Diaz, M.D.
• Linda Diaz

• Infusion Therapy Clinic/Center in Tyler, TX
• Providers in Tyler, TX by specialty
• Infusion Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.