Organization
DIABETIC TESTING SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODNEY DALE GRAY RCP. CRT (OWNER)
(210) 593-9283
Entity
Organization
Contact information
Practice address
4204 GARDENDALE, SAN ANTONIO, TX 78229-3132
(210) 593-9283
Mailing address
4204 GARDENDALE, SUITE 104, SAN ANTONIO, TX 78229-3132
(210) 593-9283
(210) 593-9284
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0055752
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156622601
—
TX
Enumeration date
11/30/2007
Last updated
10/31/2008
Update your record
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