Provider Demographics
NPI:1912760075
Name:PRIMARY TELEMED SERVICES
Entity Type:Organization
Organization Name:PRIMARY TELEMED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-342-0708
Mailing Address - Street 1:28243 OAKMONTE CIR E
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-8002
Mailing Address - Country:US
Mailing Address - Phone:248-342-0708
Mailing Address - Fax:
Practice Address - Street 1:28243 OAKMONTE CIR E
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-8002
Practice Address - Country:US
Practice Address - Phone:248-342-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care