Provider Demographics
NPI:1316695257
Name:TT MEDCO
Entity type:Organization
Organization Name:TT MEDCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-694-0739
Mailing Address - Street 1:2700 W DEYOUNG ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4943
Mailing Address - Country:US
Mailing Address - Phone:618-422-8688
Mailing Address - Fax:618-615-4273
Practice Address - Street 1:2700 W DEYOUNG ST STE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4943
Practice Address - Country:US
Practice Address - Phone:618-422-8688
Practice Address - Fax:618-615-4273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty