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General NPI Number Information
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NPI Number | 1629698766
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Entity Type | Organization
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Legal Business Name | FOREFRONT TELECARE MEDICAL SERVICES PC
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Dates
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Enumeration Date | 04/18/2020
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1627 QUARRIER ST
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City | CHARLESTON
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State | WV
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Zip | 25311-2124
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Country | US
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Telephone | 972-449-0540
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Fax | 972-449-0542
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Provider Business Mailing Address
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Address Line | 1717 MAIN ST STE 5850
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City | DALLAS
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State | TX
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Zip | 75201-7317
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Country | US
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Telephone | 972-449-0540
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Fax | 972-449-0542
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Authorized Official
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Title or Position | DIRECTOR OF PAYER OPERATIONS
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Name | SARA VITULLO
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Credential |
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Telephone | 972-449-0540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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