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General NPI Number Information
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NPI Number | 1174374011
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Entity Type | Organization
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Legal Business Name | MY TELEVISIT MD LLC
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 5560 ROOSEVELT BOULEVARD SUITE 4 #50
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City | CLEARWATER
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State | FL
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Zip | 33760
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Country | US
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Telephone | 727-415-2308
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Fax |
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Provider Business Mailing Address
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Address Line | 5560 ROOSEVELT BOULEVARD SUITE 4 #50
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City | CLEARWATER
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State | FL
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Zip | 33760-9228
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Country | US
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Telephone | 727-415-2308
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Fax |
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Authorized Official
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Title or Position | CEO/AMBR
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Name | MR. MICHAEL PAUL BAGBY
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Credential |
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Telephone | 727-415-2308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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