Provider Demographics
NPI:1487129714
Name:TLC MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:TLC MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEMANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEGABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-880-8104
Mailing Address - Street 1:3312 W FLORENCE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4782
Mailing Address - Country:US
Mailing Address - Phone:323-880-8104
Mailing Address - Fax:323-880-8204
Practice Address - Street 1:3312 W FLORENCE AVE STE D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4782
Practice Address - Country:US
Practice Address - Phone:323-880-8104
Practice Address - Fax:323-880-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADMEHS3312OtherDMEHS