Provider Demographics
NPI:1356705321
Name:TLCM LLC
Entity type:Organization
Organization Name:TLCM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMEDING
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:631-467-7755
Mailing Address - Street 1:500 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1116
Mailing Address - Country:US
Mailing Address - Phone:631-467-7755
Mailing Address - Fax:631-467-1110
Practice Address - Street 1:500 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1116
Practice Address - Country:US
Practice Address - Phone:631-467-7755
Practice Address - Fax:631-467-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36823343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02832093Medicaid