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General NPI Number Information
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NPI Number | 1487401709
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Entity Type | Organization
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Legal Business Name | TAUC IL, PC
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Dates
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Enumeration Date | 05/03/2024
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 400 BELTLINE RD
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4405
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Country | US
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Telephone | 618-215-5703
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Fax | 618-215-5704
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Provider Business Mailing Address
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Address Line | 13861 MANCHESTER RD
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City | BALLWIN
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State | MO
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Zip | 63011-4503
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Country | US
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Telephone | 636-556-0114
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Fax | 314-270-3694
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Authorized Official
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Title or Position | SENIOR CREDENTIALING SPECIALIST
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Name | TYLER TERWILLIGER
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Credential |
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Telephone | 636-220-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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