Basic Information
| Provider Information | |||||||||
| NPI: | 1831718154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TC PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 MARINER BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346095603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775305 | ||||||||
| FaxNumber: | 3526160926 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 SW SAINT LUCIE WEST BLVD STE 209 | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349861735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722048889 | ||||||||
| FaxNumber: | 7722048895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2020 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | PAGIDIPATI | ||||||||
| AuthorizedOfficialFirstName: | SIDDHARTHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7722048889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.