Provider Demographics
NPI:1952369324
Name:TLC MEDICAL GROUP - CATALINA FOOTHILLS
Entity Type:Organization
Organization Name:TLC MEDICAL GROUP - CATALINA FOOTHILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLHACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-615-6200
Mailing Address - Street 1:1775 E SKYLINE DR
Mailing Address - Street 2:STE 175
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1162
Mailing Address - Country:US
Mailing Address - Phone:520-795-3700
Mailing Address - Fax:520-901-6550
Practice Address - Street 1:1775 E SKYLINE DR
Practice Address - Street 2:STE 175
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1162
Practice Address - Country:US
Practice Address - Phone:520-795-3700
Practice Address - Fax:520-901-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110045Medicare ID - Type Unspecified