Basic Information
| Provider Information | |||||||||
| NPI: | 1902215098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IRIS TELEHEALTH MEDICAL GROUP PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 W 7TH ST STE 650 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787013039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882852269 | ||||||||
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| Practice Location | |||||||||
| Address1: | 114 W 7TH ST STE 650 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787013039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882852269 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAHEEN | ||||||||
| AuthorizedOfficialFirstName: | TARIK | ||||||||
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| AuthorizedOfficialTitleorPosition: | FOUNDER AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 4344651535 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.