Provider Demographics
NPI:1518225127
Name:FEDERAL BUREAU OF PRISONS
Entity Type:Organization
Organization Name:FEDERAL BUREAU OF PRISONS
Other - Org Name:FEDERAL CORRECTIONAL INSTITUTION, LORETTO
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR/PA-C
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRIMBATH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C/MPAS
Authorized Official - Phone:814-471-1579
Mailing Address - Street 1:772 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-7006
Mailing Address - Country:US
Mailing Address - Phone:814-471-1579
Mailing Address - Fax:814-471-1596
Practice Address - Street 1:772 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-7006
Practice Address - Country:US
Practice Address - Phone:814-471-1579
Practice Address - Fax:814-471-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal