Provider Demographics
NPI:1275126609
Name:TLC MEDICAL TRANSPORT, INC
Entity Type:Organization
Organization Name:TLC MEDICAL TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:CRITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-991-3920
Mailing Address - Street 1:PO BOX 133046
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-3046
Mailing Address - Country:US
Mailing Address - Phone:503-991-3920
Mailing Address - Fax:
Practice Address - Street 1:2475 LANCASTER DR NE STE 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4264
Practice Address - Country:US
Practice Address - Phone:503-509-6406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)