=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225700834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMOTECARE PROVIDERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2021
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 ATLANTIC AVE # 225
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02110-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-777-4199
-----------------------------------------------------
Fax | 888-777-4199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 ATLANTIC AVE # 25
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02110-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-441-2345
-----------------------------------------------------
Fax | 888-441-2345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL HEINZELMANN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 888-441-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------