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General NPI Number Information
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NPI Number | 1871507657
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Entity Type | Organization
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Legal Business Name | TELEVYDE, LLC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 3201 UNIVERSITY DR E STE 325
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City | BRYAN
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State | TX
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Zip | 77802-3478
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Country | US
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Telephone | 979-774-4563
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Fax | 979-774-4546
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Provider Business Mailing Address
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Address Line | 3201 UNIVERSITY DR E STE 325
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City | BRYAN
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State | TX
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Zip | 77802-3478
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Country | US
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Telephone | 979-774-4563
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Fax | 979-774-4546
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Authorized Official
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Title or Position | CEO
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Name | MRS. JACKIE GREENWOOD
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Credential |
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Telephone | 979-774-4563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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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 | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | R29053
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License Number State | TX
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