| Organization Name: | TELACLINIC |
| NPI Number: | 1114244704 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WALTER HOLMSTEN (PRESIDENT) |
| Mailing Address: | 117 Lane Dr Suite 2 Rosenberg |
| State: | TX US |
| Postal Code: | 774712200 |
| Phone Number: | 2816330148 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | L8734 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |