Organization
DIANNE M. GREJTAK
Active
Other names
Medical Specialty Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNE M. GREJTAK (OWNER)
(210) 614-3360
Entity
Organization
Contact information
Practice address
4944 RESEARCH DR, SAN ANTONIO, TX 78240-5006
(210) 614-3360
(210) 614-3362
Mailing address
4944 RESEARCH DR, SAN ANTONIO, TX 78240-5006
(210) 614-3360
(210) 614-3362
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0065742
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
0065742
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007451364
AETNA TRS
TX
05
—
155364601
—
TX
05
—
155364602
—
TX
01
—
190990121250
HUMANA
TX
01
—
4037010
BCBS TN
TN
01
—
531788
BCBS FEDERAL
TX
01
—
585599
BCBS KS
TX
Enumeration date
11/01/2006
Last updated
08/29/2011
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