Provider Demographics
NPI:1922342195
Name:ENCOUNTER TELEHEALTH, INC
Entity Type:Organization
Organization Name:ENCOUNTER TELEHEALTH, INC
Other - Org Name:PROVIDER SOURCE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-590-2548
Mailing Address - Street 1:900 S 74TH PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4667
Mailing Address - Country:US
Mailing Address - Phone:402-718-8846
Mailing Address - Fax:888-497-4233
Practice Address - Street 1:900 S 74TH PLZ STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4667
Practice Address - Country:US
Practice Address - Phone:844-485-3041
Practice Address - Fax:402-504-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2327Medicare PIN
IAIB3119Medicare PIN