Healthcare Provider Details

I. General information

NPI: 1629738075
Provider Name (Legal Business Name): MEDDOC TELEHEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4688 WALFORD RD APT 15
CLEVELAND OH
44128-5116
US

IV. Provider business mailing address

4688 WALFORD RD APT 15
CLEVELAND OH
44128-5116
US

V. Phone/Fax

Practice location:
  • Phone: 855-207-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARRA CAMPBELL
Title or Position: OWNER
Credential:
Phone: 855-207-6937