Provider Demographics
NPI:1437510989
Name:AMMVR GROUP, INC.
Entity Type:Organization
Organization Name:AMMVR GROUP, INC.
Other - Org Name:IMMUNO REFERENCE LAB.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-620-9770
Mailing Address - Street 1:PO BOX 195519
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5519
Mailing Address - Country:US
Mailing Address - Phone:787-999-2990
Mailing Address - Fax:787-764-8809
Practice Address - Street 1:562 MUNOZ RIVERA AVE
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-999-2990
Practice Address - Fax:787-764-8809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMMVR GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR338291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031641Medicare PIN