Provider Demographics
NPI:1861784753
Name:TCA PLC
Entity type:Organization
Organization Name:TCA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANY
Authorized Official - Middle Name:KIN MOON
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-388-1180
Mailing Address - Street 1:3217 E SHEA BLVD
Mailing Address - Street 2:441
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3340
Mailing Address - Country:US
Mailing Address - Phone:602-388-1180
Mailing Address - Fax:602-388-1180
Practice Address - Street 1:3217 E SHEA BLVD
Practice Address - Street 2:441
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3340
Practice Address - Country:US
Practice Address - Phone:602-388-1180
Practice Address - Fax:602-388-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4447207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I22556Medicare UPIN