Provider Demographics
NPI:1114244704
Name:TELACLINIC
Entity Type:Organization
Organization Name:TELACLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-633-0148
Mailing Address - Street 1:9337B KATY FWY
Mailing Address - Street 2:131
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1515
Mailing Address - Country:US
Mailing Address - Phone:281-633-0148
Mailing Address - Fax:
Practice Address - Street 1:117 LANE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2200
Practice Address - Country:US
Practice Address - Phone:281-633-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8734207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty