Provider Demographics
NPI:1609199066
Name:TLC MEDICAL TRANSPORT SVCS INC
Entity Type:Organization
Organization Name:TLC MEDICAL TRANSPORT SVCS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-422-0211
Mailing Address - Street 1:21 OSWEGO ST
Mailing Address - Street 2:PO BOX 535
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:800-927-5845
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:638 BURNET AVE
Practice Address - Street 2:EMS BILLING OFFICE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2404
Practice Address - Country:US
Practice Address - Phone:315-422-0211
Practice Address - Fax:315-428-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300017077Medicare PIN