MEDICARE: TC PHYSICIANS LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1831718154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TC PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	1202 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5603
Country	:	US
Telephone Number	:	352-277-5305
Fax Number	:	352-616-0926

Provider Business Practice Location Address
First Line	:	1100 SW SAINT LUCIE WEST BLVD STE 209
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1735
Country	:	US
Telephone Number	:	772-204-8889
Fax Number	:	772-204-8895

Authorized Official
Title or Position	:	OWNER
Name	:	SIDDHARTHA PAGIDIPATI
Credential	:
Telephone Number	:	772-204-8889

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	04/20/2020

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Directions to “TC PHYSICIANS LLC ” Practice Location

Language	Start Address	Practice Location

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