Provider Demographics
NPI:1528219029
Name:TRINITY MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:TRINITY MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHURTLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:BSBM
Authorized Official - Phone:704-573-7161
Mailing Address - Street 1:7215 LEBANON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9026
Mailing Address - Country:US
Mailing Address - Phone:704-573-7161
Mailing Address - Fax:704-573-3799
Practice Address - Street 1:7215 LEBANON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9026
Practice Address - Country:US
Practice Address - Phone:704-573-7161
Practice Address - Fax:704-573-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001663708111N00000X
NC9300746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6189500001Medicare NSC