Provider Demographics
NPI:1891196309
Name:TRUSTEES OF TRINITY COLLEGE
Entity Type:Organization
Organization Name:TRUSTEES OF TRINITY COLLEGE
Other - Org Name:TRINITY COLLEGE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ATHLETICS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:RENWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-297-2055
Mailing Address - Street 1:5050 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3995
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:300 SUMMIT ST
Practice Address - Street 2:FERRIS ATHLETIC CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3100
Practice Address - Country:US
Practice Address - Phone:860-297-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty