Provider Demographics
NPI:1396626057
Name:CEO TELEMED
Entity type:Organization
Organization Name:CEO TELEMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PAC, MPAS
Authorized Official - Phone:214-233-3094
Mailing Address - Street 1:16901 DALLAS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5208
Mailing Address - Country:US
Mailing Address - Phone:214-233-3094
Mailing Address - Fax:
Practice Address - Street 1:16901 DALLAS PKWY STE 210
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5208
Practice Address - Country:US
Practice Address - Phone:214-233-3094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty