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General NPI Number Information
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NPI Number | 1396626057
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Entity Type | Organization
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Legal Business Name | CEO TELEMED
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 16901 DALLAS PKWY STE 210
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City | ADDISON
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State | TX
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Zip | 75001-5208
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Country | US
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Telephone | 214-233-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 16901 DALLAS PKWY STE 210
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City | ADDISON
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State | TX
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Zip | 75001-5208
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Country | US
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Telephone | 214-233-3094
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSOCIATE
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Name | CHARLES ORTEGA
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Credential | PAC, MPAS
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Telephone | 214-233-3094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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