Provider Demographics
NPI:1417528571
Name:TRINITY MEDICAL PHYSICIANS, LLC
Entity Type:Organization
Organization Name:TRINITY MEDICAL PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-353-9558
Mailing Address - Street 1:550 POPE AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4679
Mailing Address - Country:US
Mailing Address - Phone:863-299-2636
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4679
Practice Address - Country:US
Practice Address - Phone:863-299-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY MEDICAL PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-08
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty