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NPI Code Detail

MEDICARE: ONLYTELEMED, LLC

MEDICARE: ONLYTELEMED, LLC
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1104491471
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONLYTELEMED, LLC
Provider Business Mailing Address
First Line : 2445 FIRE MESA ST STE 190
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-9015
Country : US
Telephone Number : 813-967-3770
Fax Number : 702-920-8848
Provider Business Practice Location Address
First Line : 2445 FIRE MESA ST STE 190
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-9015
Country : US
Telephone Number : 813-967-3770
Fax Number : 702-920-8848
Authorized Official
Title or Position : CFO
Name : MR. RICHARD MOORE
Credential :
Telephone Number : 702-970-2103
Provider Enumeration Date : 05/20/2021
Last Update Date : 05/20/2021

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Directions to “ONLYTELEMED, LLC ” Practice Location

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