Provider Demographics
NPI:1629670682
Name:ALPHATELEMEDTEXAS
Entity Type:Organization
Organization Name:ALPHATELEMEDTEXAS
Other - Org Name:ALPHATELEMEDTEXAS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-589-9964
Mailing Address - Street 1:10622 RUNAWAY LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2420
Mailing Address - Country:US
Mailing Address - Phone:703-589-9964
Mailing Address - Fax:571-252-7100
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:703-589-9964
Practice Address - Fax:571-252-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty