Provider Demographics
NPI:1174374011
Name:MY TELEVISIT MD LLC
Entity type:Organization
Organization Name:MY TELEVISIT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/AMBR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BAGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-415-2308
Mailing Address - Street 1:5560 ROOSEVELT BOULEVARD
Mailing Address - Street 2:SUITE 4 #50
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-9228
Mailing Address - Country:US
Mailing Address - Phone:727-415-2308
Mailing Address - Fax:
Practice Address - Street 1:5560 ROOSEVELT BOULEVARD
Practice Address - Street 2:SUITE 4 #50
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760
Practice Address - Country:US
Practice Address - Phone:727-415-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty