Provider Demographics
NPI:1346585718
Name:TRINITY IOM, PA
Entity Type:Organization
Organization Name:TRINITY IOM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KROPHOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-221-2900
Mailing Address - Street 1:PO BOX 204166
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-4166
Mailing Address - Country:US
Mailing Address - Phone:281-346-3480
Mailing Address - Fax:832-581-4677
Practice Address - Street 1:18302 NOYCE RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-7807
Practice Address - Country:US
Practice Address - Phone:281-346-3480
Practice Address - Fax:832-581-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty