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General NPI Number Information
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NPI Number | 1164790572
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Entity Type | Organization
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Legal Business Name | TCG CLINIC, LLC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 11301 FALLBROOK DR STE 220
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City | HOUSTON
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State | TX
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Zip | 77065-4270
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Country | US
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Telephone | 713-500-0000
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Fax | 713-500-0050
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Provider Business Mailing Address
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Address Line | 9846 HWY 31 E
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City | TYLER
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State | TX
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Zip | 75705-2329
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Country | US
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Telephone | 903-787-7609
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Fax |
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Authorized Official
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Title or Position | LICENSE & CREDENTIALING
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Name | ANGIE MARTIN
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Credential |
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Telephone | 903-787-7609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 677209
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License Number State | TX
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