Organization
TELEVYDE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE GREENWOOD (CEO)
(979) 774-4563
Entity
Organization
Contact information
Practice address
3201 UNIVERSITY DR E STE 325, BRYAN, TX 77802-3478
(979) 774-4563
(979) 774-4546
Mailing address
3201 UNIVERSITY DR E STE 325, BRYAN, TX 77802-3478
(979) 774-4563
(979) 774-4546
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
R29053
TX
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161716901
—
TX
Enumeration date
07/28/2006
Last updated
04/13/2010
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