Provider Demographics
NPI:1376130963
Name:ADVANCED TELEMEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADVANCED TELEMEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-496-6142
Mailing Address - Street 1:2654 W HORIZON RIDGE PKWY STE B5214
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2803
Mailing Address - Country:US
Mailing Address - Phone:702-468-5905
Mailing Address - Fax:
Practice Address - Street 1:3195 SAINT ROSE PKWY STE 212
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3504
Practice Address - Country:US
Practice Address - Phone:702-468-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty