| NPI | 1194598110 |
|---|---|
| Doing Business As | TELEMEDICINE PROGRAM |
| Entity Type | Organization |
| Authorized Contact | RANDY BACUS CEO 817-341-2520 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |