Provider Demographics
NPI:1790390755
Name:TLC MEDICAL, LLC
Entity Type:Organization
Organization Name:TLC MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:435-691-1746
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:UT
Mailing Address - Zip Code:84620-0233
Mailing Address - Country:US
Mailing Address - Phone:435-691-1746
Mailing Address - Fax:
Practice Address - Street 1:729 N. CLAYMILL CUTOFF RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:UT
Practice Address - Zip Code:84620-8462
Practice Address - Country:US
Practice Address - Phone:435-691-1746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care