Provider Demographics
NPI:1023366069
Name:1800TELEMEDCOM INC
Entity Type:Organization
Organization Name:1800TELEMEDCOM INC
Other - Org Name:AIRLINE MEDICAL CENTER AND DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-691-7770
Mailing Address - Street 1:5815 AIRLINE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4922
Mailing Address - Country:US
Mailing Address - Phone:713-691-7770
Mailing Address - Fax:800-520-4166
Practice Address - Street 1:5815 AIRLINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4922
Practice Address - Country:US
Practice Address - Phone:713-691-7770
Practice Address - Fax:800-520-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB151226Medicare PIN