1588805733 NPI number — TRG INVESTMENTS LLC

Table of content: (NPI 1588805733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588805733 NPI number — TRG INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRG INVESTMENTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588805733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1256 CAMPBELL LN
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-1082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-904-3499
Provider Business Mailing Address Fax Number:
270-904-3472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1256 CAMPBELL LN
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42104-1082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-904-3499
Provider Business Practice Location Address Fax Number:
270-904-3472
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RATUSNY
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
VARONA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
270-904-3499

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4813 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85002806 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6103101 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000390128 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8889 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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