Provider Demographics
NPI:1841484409
Name:JP LETELLIER MD PA
Entity type:Organization
Organization Name:JP LETELLIER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LETELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-758-4960
Mailing Address - Street 1:1004 HOBBS HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3300
Mailing Address - Country:US
Mailing Address - Phone:432-758-4960
Mailing Address - Fax:432-758-4979
Practice Address - Street 1:1004 HOBBS HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3300
Practice Address - Country:US
Practice Address - Phone:432-758-4960
Practice Address - Fax:432-758-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3003261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178909105Medicaid
TX141430OtherSUPERIOR CHIPS
TX178909106OtherMEDICAID HEALTHSTEPS
TX0025PTOtherBLUE CROSS AND BLUE SHIELD
TX141430OtherSUPERIOR CHIPS
8U7873Medicare UPIN