MEDICARE: TELEHEALTH CLINICAL EVALS, 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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346868387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELEHEALTH CLINICAL EVALS, LLC

Provider Business Mailing Address
First Line	:	9505 HILLWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0506
Country	:	US
Telephone Number	:	725-209-3053
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 HILLWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0506
Country	:	US
Telephone Number	:	725-209-3053
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	RANDALL LEE HAUPT
Credential	:
Telephone Number	:	725-209-3053

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	08/04/2025

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