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Diabetic Renewal Center LLC — NPI 1750764189, Tyler, TX | NPI Central

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NPI 1750764189

OrganizationActive

Diabetic Renewal Center LLC

NPI 1750764189 · Infusion Therapy Clinic/Center · Tyler, TX

Provider details

NPI number: 1750764189
Entity type: Organization
Primary specialty: Infusion Therapy Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Jeff Dethlefsen, Owner(903) 258-6000

Specialties & taxonomies

Infusion Therapy Clinic/CenterPrimary261QI0500XLicense 261Q10500X (TX)
Ambulatory Health Care Facilities
Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
Family Medicine Physician207Q00000XLicense F3205 (TX)
Allopathic & Osteopathic Physicians
Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians

Practice location

1015 Pruitt Pl Ste 105

Tyler, TX 75703-1154

Phone: (903) 528-6000

Fax: (903) 526-0565

Approximate (ZIP-level) locationGet directions

More TX providers

Mailing address

1015 Pruitt Pl Ste 105

Tyler, TX 75703-1154

Other names (DBA / former)

Former legal business name: Trina Health Care Center of Tyler LLC
Former legal business name: Trina Health Care Center of Tyler LLC

Additional practice locations (1)

1108 S Buffalo St
Canton, TX 75103-2304
Phone: (903) 258-6000
Fax: (903) 526-0565

Registry dates

Enumerated: 2015-07-02
Last updated: 2022-07-21

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.