MEDICARE: ABILENE ENDOCRINOLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	M7978	TX

General Provider Information

NPI Number	:	1265723472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABILENE ENDOCRINOLOGY, P.A.

Provider Business Mailing Address
First Line	:	1933 PINE ST
Second Line	:	SUITE B
City	:	ABILENE
State	:	TX
Zip	:	79601-2431
Country	:	US
Telephone Number	:	325-675-0338
Fax Number	:	325-616-5049

Provider Business Practice Location Address
First Line	:	1933 PINE ST
Second Line	:	SUITE B
City	:	ABILENE
State	:	TX
Zip	:	79601-2431
Country	:	US
Telephone Number	:	325-675-0338
Fax Number	:	325-616-5049

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EILEEN VAN DIEST
Credential	:	M.D.
Telephone Number	:	325-675-0338

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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