Provider Demographics
NPI:1942960166
Name:THE TELOS GROUP
Entity Type:Organization
Organization Name:THE TELOS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JEREMIAH
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-454-2417
Mailing Address - Street 1:6975 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6730
Mailing Address - Country:US
Mailing Address - Phone:817-201-3828
Mailing Address - Fax:817-766-7935
Practice Address - Street 1:6975 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76137-6730
Practice Address - Country:US
Practice Address - Phone:817-201-3828
Practice Address - Fax:817-766-7935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TELOS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty