Provider Demographics
NPI:1023628351
Name:ASE TELEHEALTH INC
Entity type:Organization
Organization Name:ASE TELEHEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-206-8284
Mailing Address - Street 1:5851 TIMUQUANA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7890
Mailing Address - Country:US
Mailing Address - Phone:904-416-0601
Mailing Address - Fax:904-900-6006
Practice Address - Street 1:5851 TIMUQUANA RD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7890
Practice Address - Country:US
Practice Address - Phone:904-416-0601
Practice Address - Fax:904-900-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care