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Organization
MDTELA
Active
Organization
MDTELA
Active
Other names
MDTela
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY TATUM OWNER (ADMINISTRATOR)
(931) 628-9210
Entity
Organization
Contact information
Practice address
160 SEPTEMBER DR, STREETMAN, TX 75859-3261
(833) 463-8352
Mailing address
PO BOX 946, ELKHART, TX 75839-0946
(931) 628-9210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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