Provider Demographics
NPI:1215625504
Name:TLC MOBILE CLINIC, LLC
Entity type:Organization
Organization Name:TLC MOBILE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:423-491-9741
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-0293
Mailing Address - Country:US
Mailing Address - Phone:423-491-9741
Mailing Address - Fax:423-220-3211
Practice Address - Street 1:111 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1255
Practice Address - Country:US
Practice Address - Phone:423-491-9741
Practice Address - Fax:423-220-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty