Provider Demographics
NPI:1821240300
Name:TLM MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TLM MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONIGLIARO
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-376-8875
Mailing Address - Street 1:PO BOX 1317
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-1317
Mailing Address - Country:US
Mailing Address - Phone:803-376-8875
Mailing Address - Fax:803-376-8004
Practice Address - Street 1:1707 BERNARDIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2004
Practice Address - Country:US
Practice Address - Phone:803-376-8875
Practice Address - Fax:803-376-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22363261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5036OtherMEDICAID GROUP #
SC223635Medicaid
SC9144Medicare PIN
SC223635Medicaid