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General NPI Number Information
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NPI Number | 1659821221
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Entity Type | Organization
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Legal Business Name | TCA HEALTH CARE
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1030 E. 130TH ST
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City | CHICAGO
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State | IL
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Zip | 60628
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Country | US
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Telephone | 773-995-1462
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Fax | 773-995-7985
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Provider Business Mailing Address
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Address Line | 1029 E 130TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-6908
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Country | US
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Telephone | 773-995-1462
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Fax | 773-995-7985
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MS. MARQUETTA D HALL
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Credential | MD
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Telephone | 708-856-7556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 1588701452
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1578936696
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License Number State | IL
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