Provider Demographics
NPI:1518987080
Name:TLC MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:TLC MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERGSVEINN
Authorized Official - Middle Name:
Authorized Official - Last Name:GYLFASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-252-5595
Mailing Address - Street 1:5121 SW 90TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3612
Mailing Address - Country:US
Mailing Address - Phone:954-252-5595
Mailing Address - Fax:954-680-2966
Practice Address - Street 1:5121 SW 90TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3612
Practice Address - Country:US
Practice Address - Phone:954-252-5595
Practice Address - Fax:954-680-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL362332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1313670001Medicare ID - Type Unspecified