Healthcare Provider Details

I. General information

NPI: 1720157464
Provider Name (Legal Business Name): TLC HEALTHCARE MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 NORTH CIRCULO SOBRIO
TUCSON AZ
85718-6036
US

IV. Provider business mailing address

2850 NORTH COUNTRY CLUB ROAD
TUCSON AZ
85716-1910
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-0745
  • Fax: 520-509-4496
Mailing address:
  • Phone: 520-322-6274
  • Fax: 520-509-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20393
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number20393
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT M BOLHACK
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 520-670-0745