Provider Demographics
NPI:1275924680
Name:TLA HEALTH SERVICES
Entity Type:Organization
Organization Name:TLA HEALTH SERVICES
Other - Org Name:LEGACY PAIN AND REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:972-899-9797
Mailing Address - Street 1:PO BOX 118917
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-8917
Mailing Address - Country:US
Mailing Address - Phone:972-899-9797
Mailing Address - Fax:972-899-1825
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4333
Practice Address - Country:US
Practice Address - Phone:972-899-9797
Practice Address - Fax:469-771-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-08
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty