Provider Demographics
NPI:1902826811
Name:TLC DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:TLC DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:DUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-476-9350
Mailing Address - Street 1:5517 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3630
Mailing Address - Country:US
Mailing Address - Phone:419-476-9729
Mailing Address - Fax:419-476-9650
Practice Address - Street 1:5517 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3630
Practice Address - Country:US
Practice Address - Phone:419-476-9729
Practice Address - Fax:419-476-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1425472335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3698741Medicare ID - Type UnspecifiedMOBILE X-RAY & EKG SERVIC