Provider Demographics
NPI:1649267394
Name:TLCS, P.C.
Entity type:Organization
Organization Name:TLCS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-256-1220
Mailing Address - Street 1:102 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:DES ARC
Mailing Address - State:AR
Mailing Address - Zip Code:72040-3123
Mailing Address - Country:US
Mailing Address - Phone:870-256-1220
Mailing Address - Fax:870-256-1223
Practice Address - Street 1:102 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:DES ARC
Practice Address - State:AR
Practice Address - Zip Code:72040-3123
Practice Address - Country:US
Practice Address - Phone:870-256-1220
Practice Address - Fax:870-256-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F349Medicare ID - Type UnspecifiedMEDICARE GROUP #