Provider Demographics
NPI:1194144998
Name:GTR MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:GTR MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MACHE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MILHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-913-1619
Mailing Address - Street 1:5729 LEBANON RD STE 144-571
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7260
Mailing Address - Country:US
Mailing Address - Phone:210-913-1619
Mailing Address - Fax:972-432-7585
Practice Address - Street 1:5729 LEBANON RD STE 144-571
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:210-913-1619
Practice Address - Fax:972-432-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001222332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies