Provider Demographics
NPI:1326106246
Name:TLC PEDIATRICS LTS
Entity Type:Organization
Organization Name:TLC PEDIATRICS LTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:LAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-257-9814
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:STE 280
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5366
Mailing Address - Country:US
Mailing Address - Phone:618-257-9814
Mailing Address - Fax:618-257-9802
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE 280
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5366
Practice Address - Country:US
Practice Address - Phone:618-257-9814
Practice Address - Fax:618-257-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08232033OtherBCBS OF IL