Provider Demographics
NPI:1053784660
Name:TMC PROVIDER GROUP PLLC
Entity type:Organization
Organization Name:TMC PROVIDER GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-590-5372
Mailing Address - Street 1:PO BOX 4165
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4165
Mailing Address - Country:US
Mailing Address - Phone:210-349-5577
Mailing Address - Fax:
Practice Address - Street 1:13722 EMBASSY ROW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2000
Practice Address - Country:US
Practice Address - Phone:210-349-5577
Practice Address - Fax:210-491-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0031174400000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty