Provider Demographics
NPI:1487401709
Name:TAUC IL, PC
Entity type:Organization
Organization Name:TAUC IL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TERWILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-220-1122
Mailing Address - Street 1:13861 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4503
Mailing Address - Country:US
Mailing Address - Phone:636-556-0114
Mailing Address - Fax:314-270-3694
Practice Address - Street 1:400 BELTLINE RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4405
Practice Address - Country:US
Practice Address - Phone:618-215-5703
Practice Address - Fax:618-215-5704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAUC IL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-03
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care