Provider Demographics
NPI:1790385276
Name:TRUMEDIS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:TRUMEDIS HEALTHCARE SERVICES
Other - Org Name:TRUMEDIS HEALTHCARE SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUBOUE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:443-310-4127
Mailing Address - Street 1:6120 BALTIMORE NATIONAL PIKE STE 204
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6120 BALTIMORE NATIONAL PIKE STE 204
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2930
Practice Address - Country:US
Practice Address - Phone:443-310-4127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty