Provider Demographics
NPI: | 1497986160 |
---|---|
Name: | TLC PHYSICIAN SERVICES OF TEXAS INC |
Entity Type: | Organization |
Organization Name: | TLC PHYSICIAN SERVICES OF TEXAS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERTO |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | PANTOJA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-425-4200 |
Mailing Address - Street 1: | 8 CADILLAC DR |
Mailing Address - Street 2: | STE. 250 |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-5087 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-425-4200 |
Mailing Address - Fax: | 615-425-4271 |
Practice Address - Street 1: | 8 CADILLAC DR |
Practice Address - Street 2: | STE. 250 |
Practice Address - City: | BRENTWOOD |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37027-5087 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-425-4200 |
Practice Address - Fax: | 615-425-4271 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-07-29 |
Last Update Date: | 2009-07-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |