Provider Demographics
NPI:1275098568
Name:IDOC VIRTUAL TELEHEALTH TEXAS
Entity Type:Organization
Organization Name:IDOC VIRTUAL TELEHEALTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RENTERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-633-8153
Mailing Address - Street 1:PO BOX 280113
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-0113
Mailing Address - Country:US
Mailing Address - Phone:713-913-1422
Mailing Address - Fax:303-922-4640
Practice Address - Street 1:2311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3218
Practice Address - Country:US
Practice Address - Phone:713-913-1422
Practice Address - Fax:303-922-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty
No2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical CareGroup - Multi-Specialty