1992435887 NPI number — TLC MEDICAL LLC

Table of content: (NPI 1992435887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992435887 NPI number — TLC MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992435887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14231-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-281-8529
Provider Business Mailing Address Fax Number:
716-770-1918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11300 STONEWALL JACKSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOTSYLVANIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22551-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-281-8529
Provider Business Practice Location Address Fax Number:
716-770-1918
Provider Enumeration Date:
06/14/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KASHUBA
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
716-548-1112

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)