Provider Demographics
NPI:1225530108
Name:TRINITY MEDICAL GROUP AND TECHNOLOGIES
Entity Type:Organization
Organization Name:TRINITY MEDICAL GROUP AND TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:DION
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-262-7242
Mailing Address - Street 1:1817 SE 13TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-8395
Mailing Address - Country:US
Mailing Address - Phone:352-262-7242
Mailing Address - Fax:
Practice Address - Street 1:1817 SE 13TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-8395
Practice Address - Country:US
Practice Address - Phone:352-262-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty