Provider Demographics
NPI:1497779169
Name:TRINITY MEDICAL ASSOCIATES L L C
Entity Type:Organization
Organization Name:TRINITY MEDICAL ASSOCIATES L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-375-2222
Mailing Address - Street 1:3633 LITTLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1815
Mailing Address - Country:US
Mailing Address - Phone:727-375-2222
Mailing Address - Fax:866-244-2335
Practice Address - Street 1:3633 LITTLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1818
Practice Address - Country:US
Practice Address - Phone:727-375-2222
Practice Address - Fax:866-244-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4295Medicare ID - Type Unspecified
FLG84857Medicare UPIN