Provider Demographics
NPI:1467195354
Name:TRIDENT MEDICAL INTERNATIONAL
Entity Type:Organization
Organization Name:TRIDENT MEDICAL INTERNATIONAL
Other - Org Name:TRIDENT HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-212-1450
Mailing Address - Street 1:72 LASKEY LN
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1633
Mailing Address - Country:US
Mailing Address - Phone:844-212-1450
Mailing Address - Fax:207-433-1153
Practice Address - Street 1:447 MAIN RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:ME
Practice Address - Zip Code:04419-3547
Practice Address - Country:US
Practice Address - Phone:844-212-1450
Practice Address - Fax:207-433-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty