Provider Demographics
NPI:1346085719
Name:TELE MED CLINIX LOUSIANA
Entity type:Organization
Organization Name:TELE MED CLINIX LOUSIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-209-4040
Mailing Address - Street 1:570 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1026
Mailing Address - Country:US
Mailing Address - Phone:321-209-4040
Mailing Address - Fax:321-999-9240
Practice Address - Street 1:215 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6520
Practice Address - Country:US
Practice Address - Phone:321-209-4040
Practice Address - Fax:321-999-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)