MEDICARE: TMC PROVIDER GROUP, PLLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1669181681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC PROVIDER GROUP, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4165
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8465 MEMORIAL BLVD STE 300
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-7024
Country	:	US
Telephone Number	:	409-344-4220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERICA HAUSER
Credential	:
Telephone Number	:	312-590-5372

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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