MEDICARE: TC SURGICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	SA00014	TX

General Provider Information

NPI Number	:	1093932964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TC SURGICAL, INC.

Provider Business Mailing Address
First Line	:	8412 PARK BROOK CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-0901
Country	:	US
Telephone Number	:	817-690-8708
Fax Number	:	817-577-5793

Provider Business Practice Location Address
First Line	:	8412 PARK BROOK CT
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-0901
Country	:	US
Telephone Number	:	817-690-8708
Fax Number	:	817-577-5793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GAYLON KLOPFENSTEIN
Credential	:	LSA, CFA
Telephone Number	:	817-690-8708

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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