Provider Demographics
NPI:1164854428
Name:TCG CLINIC, LLC
Entity Type:Organization
Organization Name:TCG CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-383-2100
Mailing Address - Street 1:9220 KIRBY DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2533
Mailing Address - Country:US
Mailing Address - Phone:713-383-2100
Mailing Address - Fax:713-383-2113
Practice Address - Street 1:9220 KIRBY DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2533
Practice Address - Country:US
Practice Address - Phone:713-383-2100
Practice Address - Fax:713-383-2113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TCG CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation