# MY TELEVISIT MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174374011
- **Authorized official:** MR. MICHAEL PAUL BAGBY (CEO/AMBR)
- **Authorized official phone:** (727) 415-2308

## Contact information

- **Practice address:** 5560 ROOSEVELT BOULEVARD, SUITE 4 \#50, CLEARWATER, FL 33760
- **Practice address phone:** (727) 415-2308
- **Mailing address:** 5560 ROOSEVELT BOULEVARD, SUITE 4 \#50, CLEARWATER, FL 33760-9228
- **Mailing address phone:** (727) 415-2308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 133NN1002X | Nutrition Education Nutritionist | — | — | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | — | — |
| 261QR0800X | Recovery Care Clinic/Center | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | — | — |
| 374U00000X | Home Health Aide | — | — | — |

## Other

- **Enumeration date:** 03/28/2024
- **Last updated:** 03/28/2024