Provider Demographics
NPI:1356361224
Name:TELO MEDICAL SERVICES INC
Entity type:Organization
Organization Name:TELO MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF TELO MEDICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:REDT, RCS, CCT
Authorized Official - Phone:305-301-6851
Mailing Address - Street 1:3282 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4825
Mailing Address - Country:US
Mailing Address - Phone:305-301-6851
Mailing Address - Fax:305-480-9256
Practice Address - Street 1:1790 W 49TH ST
Practice Address - Street 2:SUITE 305-3
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2992
Practice Address - Country:US
Practice Address - Phone:305-826-4888
Practice Address - Fax:305-480-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113692085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE-1526Medicare ID - Type UnspecifiedI.D.T.F