MEDICARE: SPRING TELEHEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1780530550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING TELEHEALTH

Provider Business Mailing Address
First Line	:	30411 RUSSELL POINT DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-3448
Country	:	US
Telephone Number	:	361-232-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	30411 RUSSELL POINT DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-3448
Country	:	US
Telephone Number	:	361-232-8833
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	MANJUKA WIJEWARDENA
Credential	:	APRN
Telephone Number	:	361-232-8833

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “SPRING TELEHEALTH ” Practice Location

Language	Start Address	Practice Location

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