Provider Demographics
NPI:1285124420
Name:TELEMEDICINE PROVIDER SERVICES
Entity type:Organization
Organization Name:TELEMEDICINE PROVIDER SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-255-6037
Mailing Address - Street 1:1919 14TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5482
Mailing Address - Country:US
Mailing Address - Phone:303-952-5033
Mailing Address - Fax:
Practice Address - Street 1:1919 14TH ST STE 700
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5482
Practice Address - Country:US
Practice Address - Phone:303-952-5033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty