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General NPI Number Information
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NPI Number | 1972092823
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Entity Type | Organization
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Legal Business Name | TELEMEDVIP PHYSICIAN GROUP, PLLC
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 1011 AUGUSTA DR STE 102
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City | HOUSTON
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State | TX
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Zip | 77057-2035
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Country | US
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Telephone | 713-452-1873
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 AUGUSTA DR STE 102
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City | HOUSTON
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State | TX
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Zip | 77057-2035
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Country | US
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Telephone | 713-452-1873
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. THOMAS F UPDIKE JR.
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Credential | PHD
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Telephone | 713-452-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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