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NPI Code Detail

MEDICARE: TCOH PC

MEDICARE: TCOH PC
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
1261QX0100XOccupational Medicine Clinic/Center

General Provider Information

NPI Number : 1154337913
Entity Type Code : Organization
Provider Name (Legal Business Name) : TCOH PC
Provider Business Mailing Address
First Line : 2520 PILOT KNOB RD
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1137
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2520 PILOT KNOB RD
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1137
Country : US
Telephone Number : 651-224-8264
Fax Number :
Authorized Official
Title or Position : CLINIC ADMINISTRATOR
Name : JANICE K BAVERTY
Credential :
Telephone Number : 651-224-8264
Provider Enumeration Date : 08/01/2006
Last Update Date : 10/20/2010

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Directions to “TCOH PC ” Practice Location

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