MEDICARE: DIANNE M. GREJTAK

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	332BX2000X	Oxygen Equipment & Supplies (DME)	0065742	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	0065742	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007451364	OTHER	TX	AETNA TRS
2	531788	OTHER	TX	BCBS FEDERAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	531788	OTHER	TX	BCBS TX
5	190990121250	OTHER	TX	HUMANA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4037010	OTHER	TN	BCBS TN
8	585599	OTHER	TX	BCBS KS

General Provider Information

NPI Number	:	1891872719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANNE M. GREJTAK

Provider Business Mailing Address
First Line	:	4944 RESEARCH DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-5006
Country	:	US
Telephone Number	:	210-614-3360
Fax Number	:	210-614-3362

Provider Business Practice Location Address
First Line	:	4944 RESEARCH DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-5006
Country	:	US
Telephone Number	:	210-614-3360
Fax Number	:	210-614-3362

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DIANNE M. GREJTAK
Credential	:
Telephone Number	:	210-614-3360

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/29/2011

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Directions to “DIANNE M. GREJTAK ” Practice Location

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