Provider Demographics
NPI:1477028579
Name:TELEMED OF TX LLC
Entity Type:Organization
Organization Name:TELEMED OF TX LLC
Other - Org Name:TELEMED OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-463-0070
Mailing Address - Street 1:415 PENDALL DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5564
Mailing Address - Country:US
Mailing Address - Phone:469-463-0070
Mailing Address - Fax:
Practice Address - Street 1:415 PENDALL DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5564
Practice Address - Country:US
Practice Address - Phone:469-463-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP123975OtherTEXAS BOARD OF NURSING LICENSE
TXAP123975OtherTEXAS BOARD OF NURSING LICENSE