Provider Demographics
NPI:1164889838
Name:TR MEDICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:TR MEDICAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-785-1228
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0926
Mailing Address - Country:US
Mailing Address - Phone:787-785-1228
Mailing Address - Fax:
Practice Address - Street 1:49 CALLE I
Practice Address - Street 2:EXTENSION HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-0000
Practice Address - Country:US
Practice Address - Phone:787-785-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3396174400000X
PR12858174400000X
PR13339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89622Medicare PIN
PR20334Medicare PIN
PR94562Medicare PIN