Provider Demographics
NPI:1841600830
Name:TRIMANA LLC
Entity Type:Organization
Organization Name:TRIMANA LLC
Other - Org Name:VIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRRANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:479-301-8829
Mailing Address - Street 1:2875 E JOYCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4524
Mailing Address - Country:US
Mailing Address - Phone:479-966-4999
Mailing Address - Fax:479-966-4987
Practice Address - Street 1:2875 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4524
Practice Address - Country:US
Practice Address - Phone:479-966-4999
Practice Address - Fax:479-966-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty