Provider Demographics
NPI:1770228371
Name:FAMILY TELEMED PLLC
Entity Type:Organization
Organization Name:FAMILY TELEMED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-835-3633
Mailing Address - Street 1:18530 W CARLOTA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1612
Mailing Address - Country:US
Mailing Address - Phone:785-835-3633
Mailing Address - Fax:623-303-8933
Practice Address - Street 1:18530 W CARLOTA LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-1612
Practice Address - Country:US
Practice Address - Phone:785-835-3633
Practice Address - Fax:623-303-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty