Healthcare Provider Details

I. General information

NPI: 1023366069
Provider Name (Legal Business Name): 1800TELEMEDCOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 AIRLINE DR SUITE A
HOUSTON TX
77076-4922
US

IV. Provider business mailing address

5815 AIRLINE DR SUITE A
HOUSTON TX
77076-4922
US

V. Phone/Fax

Practice location:
  • Phone: 713-691-7770
  • Fax: 800-520-4166
Mailing address:
  • Phone: 713-691-7770
  • Fax: 800-520-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA BIBBS
Title or Position: C.E.O.
Credential:
Phone: 713-691-7770