Healthcare Provider Details

I. General information

NPI: 1285124420
Provider Name (Legal Business Name): TELEMEDICINE PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 14TH ST STE 700
BOULDER CO
80302-5482
US

IV. Provider business mailing address

1919 14TH ST STE 700
BOULDER CO
80302-5482
US

V. Phone/Fax

Practice location:
  • Phone: 303-952-5033
  • Fax:
Mailing address:
  • Phone: 303-952-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID WIEBE
Title or Position: OWNER
Credential: MD
Phone: 720-255-6037