Provider Demographics
NPI:1588101208
Name:TICO TELEHEALTH INC.
Entity type:Organization
Organization Name:TICO TELEHEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-775-5779
Mailing Address - Street 1:7300 REMCON CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1647
Mailing Address - Country:US
Mailing Address - Phone:915-532-3600
Mailing Address - Fax:
Practice Address - Street 1:4624 FORT CROCKETT BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551
Practice Address - Country:US
Practice Address - Phone:512-775-5779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH9088OtherLICENSE
TX120358001Medicaid
TX120358001Medicaid
TXC03417Medicare UPIN