Healthcare Provider Details

I. General information

NPI: 1033997671
Provider Name (Legal Business Name): TELEWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 06/27/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21400 W DIXIE HWY
MIAMI FL
33180-1144
US

IV. Provider business mailing address

6415 ROCKHURST RD
BETHESDA MD
20817-1637
US

V. Phone/Fax

Practice location:
  • Phone: 240-291-5145
  • Fax:
Mailing address:
  • Phone: 240-201-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GAYER
Title or Position: COO
Credential: COO
Phone: 240-291-5145