Provider Demographics
NPI:1639768930
Name:TRDG/WASHINGTON, LLC
Entity Type:Organization
Organization Name:TRDG/WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLIRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-978-1010
Mailing Address - Street 1:7000 N 39TH PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3274
Mailing Address - Country:US
Mailing Address - Phone:724-978-1010
Mailing Address - Fax:
Practice Address - Street 1:900 WILDFLOWER CIR STE 904
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9782
Practice Address - Country:US
Practice Address - Phone:724-978-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306258108OtherNPI
1497141667OtherNPI
1861745275OtherNPI
1184838112OtherNPI