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General NPI Number Information
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NPI Number | 1891872719
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Entity Type | Organization
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Legal Business Name | DIANNE M. GREJTAK
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 4944 RESEARCH DR
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City | SAN ANTONIO
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State | TX
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Zip | 78240-5006
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Country | US
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Telephone | 210-614-3360
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Fax | 210-614-3362
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Provider Business Mailing Address
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Address Line | 4944 RESEARCH DR
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City | SAN ANTONIO
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State | TX
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Zip | 78240-5006
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Country | US
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Telephone | 210-614-3360
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Fax | 210-614-3362
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Authorized Official
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Title or Position | OWNER
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Name | MS. DIANNE M. GREJTAK
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Credential |
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Telephone | 210-614-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0065742
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0065742
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License Number State | TX
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