1922342195 NPI number — ENCOUNTER TELEHEALTH, INC

Table of content: (NPI 1922342195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922342195 NPI number — ENCOUNTER TELEHEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCOUNTER TELEHEALTH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROVIDER SOURCE, LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922342195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 S 74TH PLZ STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-4667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-718-8846
Provider Business Mailing Address Fax Number:
888-497-4233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 S 74TH PLZ STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-485-3041
Provider Business Practice Location Address Fax Number:
402-504-9515
Provider Enumeration Date:
11/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMIS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
402-590-2548

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)