Provider Demographics
NPI:1457702813
Name:TIC, LLC
Entity type:Organization
Organization Name:TIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-888-1329
Mailing Address - Street 1:6 FIELDSTONE CMNS
Mailing Address - Street 2:SUITE E
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3419
Mailing Address - Country:US
Mailing Address - Phone:860-896-4848
Mailing Address - Fax:860-896-4849
Practice Address - Street 1:6 FIELDSTONE CMNS
Practice Address - Street 2:SUITE E
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3419
Practice Address - Country:US
Practice Address - Phone:860-896-4848
Practice Address - Fax:860-896-4849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-28
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty