Provider Demographics
NPI:1962907535
Name:TELEMED HEALTH GROUP
Entity type:Organization
Organization Name:TELEMED HEALTH GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-288-6228
Mailing Address - Street 1:1199 S FEDERAL HWY STE 190
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7335
Mailing Address - Country:US
Mailing Address - Phone:561-948-4505
Mailing Address - Fax:
Practice Address - Street 1:8 THE GRN STE D
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3618
Practice Address - Country:US
Practice Address - Phone:561-922-3953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1891234936
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty