Provider Demographics
NPI:1225435720
Name:TLJ MEDICAL
Entity Type:Organization
Organization Name:TLJ MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-228-2473
Mailing Address - Street 1:20 TOWNE DR
Mailing Address - Street 2:SUITE 276
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4204
Mailing Address - Country:US
Mailing Address - Phone:912-349-6892
Mailing Address - Fax:912-349-6898
Practice Address - Street 1:20 TOWNE DR
Practice Address - Street 2:SUITE 276
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4204
Practice Address - Country:US
Practice Address - Phone:912-228-2473
Practice Address - Fax:912-335-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies