Provider Demographics
NPI:1093159139
Name:CARLOS F. TREVINO, M.D., P.C.
Entity Type:Organization
Organization Name:CARLOS F. TREVINO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:406-488-2574
Mailing Address - Street 1:181 12TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3613
Mailing Address - Country:US
Mailing Address - Phone:406-488-2574
Mailing Address - Fax:406-488-5514
Practice Address - Street 1:181 12TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3613
Practice Address - Country:US
Practice Address - Phone:406-488-2574
Practice Address - Fax:406-488-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10214261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center