| My Home Telemed LLC | |
|
1156 Piedmont Rd Venice FL 34293-4843 | |
| (609) 432-5417 | |
| Not Available |
| Full Name | My Home Telemed LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1156 Piedmont Rd, Venice, Florida |
| Authorized Official Name and Position | Denise S Trumbauer (OWNER, CEO) |
| Authorized Official Contact | 6094325417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Home Telemed LLC 106 Anita Dr Egg Harbor Township NJ 08234-7522 Ph: (609) 432-5417 | My Home Telemed LLC 1156 Piedmont Rd Venice FL 34293-4843 Ph: (609) 432-5417 |
| NPI Number | 1548848906 |
|---|---|
| Provider Enumeration Date | 03/29/2021 |
| Last Update Date | 03/29/2021 |
| Certification Date | 03/29/2021 |
| Medicare PECOS PAC ID | 2860800489 |
|---|---|
| Medicare Enrollment ID | O20210712003378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548848906 | NPI | - | NPPES |
| 60062926 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (NU) | Primary |
| Provider Name | Denise S Trumbauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477558351 PECOS PAC ID: 6406812692 Enrollment ID: I20041209000173 |
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