Provider Demographics
NPI:1417479635
Name:TCSC EV LLC
Entity Type:Organization
Organization Name:TCSC EV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-715-1657
Mailing Address - Street 1:1114 S HIGLEY RD STE 101-A
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3000
Mailing Address - Country:US
Mailing Address - Phone:602-715-1654
Mailing Address - Fax:
Practice Address - Street 1:1114 S HIGLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3000
Practice Address - Country:US
Practice Address - Phone:602-715-1654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical