Provider Demographics
NPI:1376165191
Name:TELEMEDICINE ADVANTAGE CONCIERGE URGENT CARE
Entity Type:Organization
Organization Name:TELEMEDICINE ADVANTAGE CONCIERGE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-992-5551
Mailing Address - Street 1:4200 SOUTH FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1407
Mailing Address - Country:US
Mailing Address - Phone:817-992-5551
Mailing Address - Fax:817-910-6120
Practice Address - Street 1:4200 SOUTH FWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1407
Practice Address - Country:US
Practice Address - Phone:817-992-5551
Practice Address - Fax:817-910-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty