Provider Demographics
NPI:1831718154
Name:TC PHYSICIANS LLC
Entity type:Organization
Organization Name:TC PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDDHARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGIDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-204-8889
Mailing Address - Street 1:1202 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5603
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD STE 209
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1735
Practice Address - Country:US
Practice Address - Phone:772-204-8889
Practice Address - Fax:772-204-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care