Provider Demographics
NPI:1497797948
Name:MICHAEL R. TRIMBLE M.D., F.A.C.S
Entity Type:Organization
Organization Name:MICHAEL R. TRIMBLE M.D., F.A.C.S
Other - Org Name:MICHAEL R. TRIMBLE M.D., F.A.C.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-704-6070
Mailing Address - Street 1:1514 GOLDRUSH RD
Mailing Address - Street 2:STE. A-18
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8375
Mailing Address - Country:US
Mailing Address - Phone:928-704-6070
Mailing Address - Fax:
Practice Address - Street 1:1514 GOLDRUSH RD
Practice Address - Street 2:STE. A-18
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8375
Practice Address - Country:US
Practice Address - Phone:928-704-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ99999OtherMUTUAL OF OMAHA PROVIDER
AZ83012OtherMEDICARE PIN NUMBER
AZ83012OtherMEDICARE PIN NUMBER
AZ=========Medicaid
AZC64255Medicare UPIN