Provider Demographics
NPI:1972092823
Name:TELEMEDVIP PHYSICIAN GROUP, PLLC
Entity type:Organization
Organization Name:TELEMEDVIP PHYSICIAN GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:UPDIKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-452-1873
Mailing Address - Street 1:1011 AUGUSTA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2035
Mailing Address - Country:US
Mailing Address - Phone:713-452-1873
Mailing Address - Fax:
Practice Address - Street 1:1011 AUGUSTA DR STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2035
Practice Address - Country:US
Practice Address - Phone:713-452-1873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty