Provider Demographics
NPI:1194837401
Name:TCL HEALTHCARE, INC
Entity Type:Organization
Organization Name:TCL HEALTHCARE, INC
Other - Org Name:PATIENT REQUEST MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-621-3778
Mailing Address - Street 1:27955 US HIGHWAY 98
Mailing Address - Street 2:STE K
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4735
Mailing Address - Country:US
Mailing Address - Phone:251-621-3778
Mailing Address - Fax:251-621-3970
Practice Address - Street 1:27955 US HIGHWAY 98
Practice Address - Street 2:STE K
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4735
Practice Address - Country:US
Practice Address - Phone:251-621-3778
Practice Address - Fax:251-621-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL522332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4830170001Medicare ID - Type Unspecified