Organization
DIABETIC RENEWAL CENTER LLC
Active
Other names
TRINA HEALTH CARE CENTER OF TYLER LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF E DETHLEFSEN (OWNER)
(903) 258-6000
Entity
Organization
Contact information
Practice address
1015 PRUITT PL STE 105, TYLER, TX 75703-1154
(903) 528-6000
(903) 526-0565
Mailing address
1015 PRUITT PL STE 105, TYLER, TX 75703-1154
(903) 258-6000
(903) 526-0565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F3205
TX
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
261Q10500X
TX
Other
Enumeration date
07/02/2015
Last updated
07/21/2022
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