Provider Demographics
NPI:1003846999
Name:TSR THERAPEUTICS, INC.
Entity Type:Organization
Organization Name:TSR THERAPEUTICS, INC.
Other - Org Name:TSR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UFOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPED, COF
Authorized Official - Phone:817-640-5526
Mailing Address - Street 1:PO BOX 5433
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-5433
Mailing Address - Country:US
Mailing Address - Phone:817-640-5526
Mailing Address - Fax:817-640-5537
Practice Address - Street 1:1414 W RANDOL MILL RD
Practice Address - Street 2:STE. 112
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3159
Practice Address - Country:US
Practice Address - Phone:817-640-5526
Practice Address - Fax:817-640-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088859332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161241801Medicaid
TX161241801Medicaid