Basic Information
| Provider Information | |||||||||
| NPI: | 1952369324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TLC MEDICAL GROUP - CATALINA FOOTHILLS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 E SKYLINE DR | ||||||||
| Address2: | STE 175 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857181162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207953700 | ||||||||
| FaxNumber: | 5209016550 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 E SKYLINE DR | ||||||||
| Address2: | STE 175 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857181162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207953700 | ||||||||
| FaxNumber: | 5209016550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOLHACK | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5206156200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | PENDING | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.