Provider Demographics
NPI:1134691744
Name:TRINITY GERIATRICS PA
Entity Type:Organization
Organization Name:TRINITY GERIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI-OFODILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-760-1971
Mailing Address - Street 1:11901 SHADOW CREEK PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7346
Mailing Address - Country:US
Mailing Address - Phone:281-760-1971
Mailing Address - Fax:888-257-3780
Practice Address - Street 1:11901 SHADOW CREEK PKWY STE 111
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7346
Practice Address - Country:US
Practice Address - Phone:281-760-1971
Practice Address - Fax:888-257-3780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVTER G INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty