Provider Demographics
NPI:1851840961
Name:TELE DOCTOR DIRECT INC
Entity Type:Organization
Organization Name:TELE DOCTOR DIRECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-513-1085
Mailing Address - Street 1:101 S REID ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7030
Mailing Address - Country:US
Mailing Address - Phone:844-329-6100
Mailing Address - Fax:
Practice Address - Street 1:1250 POWERS FERRY CMN SE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6046
Practice Address - Country:US
Practice Address - Phone:844-329-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty