Provider Demographics
NPI:1649584038
Name:TLC PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:TLC PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-2444
Mailing Address - Street 1:955 CAROLYN LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5015
Mailing Address - Country:US
Mailing Address - Phone:501-327-2444
Mailing Address - Fax:501-327-2443
Practice Address - Street 1:955 CAROLYN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5015
Practice Address - Country:US
Practice Address - Phone:501-327-2444
Practice Address - Fax:501-327-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G341OtherBCBS
AR183907002Medicaid
ARF27548Medicare UPIN