Healthcare Provider Details

I. General information

NPI: 1831718154
Provider Name (Legal Business Name): TC PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SW SAINT LUCIE WEST BLVD STE 209
PORT ST LUCIE FL
34986-1735
US

IV. Provider business mailing address

1202 MARINER BLVD
SPRING HILL FL
34609-5603
US

V. Phone/Fax

Practice location:
  • Phone: 772-204-8889
  • Fax: 772-204-8895
Mailing address:
  • Phone: 352-277-5305
  • Fax: 352-616-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIDDHARTHA PAGIDIPATI
Title or Position: OWNER
Credential:
Phone: 772-204-8889