Provider Demographics
NPI:1538481684
Name:TRINITY INTEGRATIVE MEDICINE PA
Entity Type:Organization
Organization Name:TRINITY INTEGRATIVE MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-875-7627
Mailing Address - Street 1:10935 TERRITORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1156
Mailing Address - Country:US
Mailing Address - Phone:612-875-7627
Mailing Address - Fax:
Practice Address - Street 1:2434 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1269
Practice Address - Country:US
Practice Address - Phone:612-875-7627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42380261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care