Provider Demographics
NPI:1073269270
Name:IDEA TELEMEDICINE SERVICES LLC
Entity Type:Organization
Organization Name:IDEA TELEMEDICINE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-570-9302
Mailing Address - Street 1:5615 DUNBARTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8216
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:
Practice Address - Street 1:74 4TH ST N
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-1857
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:833-888-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center