Provider Demographics
NPI:1467988923
Name:TLE HEALTHCARE LLC
Entity Type:Organization
Organization Name:TLE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:214-912-2256
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-1598
Mailing Address - Country:US
Mailing Address - Phone:214-912-2256
Mailing Address - Fax:800-942-1772
Practice Address - Street 1:3400 BURRWOOD CIR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5440
Practice Address - Country:US
Practice Address - Phone:214-912-2256
Practice Address - Fax:800-942-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty