Healthcare Provider Details

I. General information

NPI: 1871507657
Provider Name (Legal Business Name): TELEVYDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E STE 325
BRYAN TX
77802-3478
US

IV. Provider business mailing address

3201 UNIVERSITY DR E STE 325
BRYAN TX
77802-3478
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-4563
  • Fax: 979-774-4546
Mailing address:
  • Phone: 979-774-4563
  • Fax: 979-774-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberR29053
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE GREENWOOD
Title or Position: CEO
Credential:
Phone: 979-774-4563