Provider Demographics
NPI:1982698171
Name:LINDA L. WANAMAKER PTR
Entity Type:Organization
Organization Name:LINDA L. WANAMAKER PTR
Other - Org Name:TENDER LOVING CARE MEDICAL OR TLC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-562-8777
Mailing Address - Street 1:124 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2219
Mailing Address - Country:US
Mailing Address - Phone:419-562-8777
Mailing Address - Fax:419-562-0921
Practice Address - Street 1:124 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2219
Practice Address - Country:US
Practice Address - Phone:419-562-8777
Practice Address - Fax:419-562-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH21452332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000302697OtherANTHEM BLUE CROSS
OH0949180001Medicare NSC