Provider Demographics
NPI:1780158873
Name:CLINICIANS IN TELEMEDICINE LLC
Entity type:Organization
Organization Name:CLINICIANS IN TELEMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-699-5426
Mailing Address - Street 1:1678 BEEMAN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181-5360
Mailing Address - Country:US
Mailing Address - Phone:304-699-5426
Mailing Address - Fax:304-551-0053
Practice Address - Street 1:1678 BEEMAN RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26181-5360
Practice Address - Country:US
Practice Address - Phone:304-699-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty