| Mdtela Professional Limited | |
|
160 September Dr Streetman TX 75859-3261 | |
| (931) 628-9210 | |
| (562) 381-7291 |
| Full Name | Mdtela Professional Limited |
|---|---|
| Speciality | Clinic/Center |
| Location | 160 September Dr, Streetman, Texas |
| Authorized Official Name and Position | Kimberly Tatum (OWNER) |
| Authorized Official Contact | 9095992852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mdtela Professional Limited 160 September Dr Streetman TX 75859-3261 Ph: (931) 628-9210 | Mdtela Professional Limited 160 September Dr Streetman TX 75859-3261 Ph: (931) 628-9210 |
| NPI Number | 1083299101 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 03/10/2021 |
| Medicare PECOS PAC ID | 6709293962 |
|---|---|
| Medicare Enrollment ID | O20210406000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083299101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Joshua D Allen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982904033 PECOS PAC ID: 6507041357 Enrollment ID: I20110421000312 |
| Provider Name | Kimberly Modena Tatum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518479542 PECOS PAC ID: 2769562487 Enrollment ID: I20200211000125 |
Dragonfly Telehealth, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 160 September Dr, Streetman, TX 75859 Phone: 931-628-9210 | |
Mdtela Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 160 September Dr, Streetman, TX 75859 Phone: 833-463-8352 | |
Mexia Principal Healthcare Limited Partnership Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 North Houston St, Streetman, TX 75859 Phone: 903-599-1707 Fax: 903-599-1107 |