Provider Demographics
NPI:1629310230
Name:TRINITY LOVELESS, MD, PLLC
Entity Type:Organization
Organization Name:TRINITY LOVELESS, MD, PLLC
Other - Org Name:A PLACE TO GROW PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-265-3900
Mailing Address - Street 1:812 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6719
Mailing Address - Country:US
Mailing Address - Phone:405-265-3900
Mailing Address - Fax:405-265-3905
Practice Address - Street 1:812 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6719
Practice Address - Country:US
Practice Address - Phone:405-265-3900
Practice Address - Fax:405-265-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25703261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200173810AMedicaid