Practitioner & Office
Practitioner Name
Stacie LeClair
Office Name
ToothTalk
Practice ID
0037061835
EIN
Add EIN
Group NPI
Add Group NPI
Office Email
drevl@mac.com
Phone No
(813) 919-5828
Address
7315 Brightwater Oaks Dr, Tampa, FL 33625
Compliance & Certificates
Manage DocsFCC.GOV Certificate
OSHA & HIPAA Certificates
OpenTelemed Cert
OIG Compliance Plan Writing and Certification
HIPAA IT Setup
HRSA HHS Certificate
SAM.GOV UEI Certificate
Agreement Copy
Malpractice Insurance
Patient Forms
Business Website
Collaborative Physician
Billing Contractor
Billing Contractor 1099 NEC
Fees Paid by OpenTelemed
Total Patients
0
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Total OON Credit
$0
All patients
Available Credit
$0
Unspent
Used Credit
$0
Spent
Patients
| Patient Name | Patient Source | Assigned ID | Phone No | Address | Total OON Credit | Available Credit | Last eVisit | Medical Hx | Assigned Date |
|---|