Provider Demographics
NPI:1154404085
Name:TCS MEDICAL GROUP INC
Entity type:Organization
Organization Name:TCS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-605-8013
Mailing Address - Street 1:PO BOX 991826
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1826
Mailing Address - Country:US
Mailing Address - Phone:530-244-5833
Mailing Address - Fax:866-647-3121
Practice Address - Street 1:821 CHERRYHILL TRL
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2834
Practice Address - Country:US
Practice Address - Phone:530-605-8013
Practice Address - Fax:866-647-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0041740Medicaid
CACE998AOtherMEDICARE NO CA