Provider Demographics
NPI:1326351677
Name:TRAPEX MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:TRAPEX MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-1165
Mailing Address - Street 1:4600 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3307
Mailing Address - Country:US
Mailing Address - Phone:954-533-1165
Mailing Address - Fax:
Practice Address - Street 1:4600 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE # 6
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3307
Practice Address - Country:US
Practice Address - Phone:954-533-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TC0700X, 103TP0016X, 106H00000X, 111NR0400X, 261QM0801X, 261QM0850X, 261QM0855X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty