Provider Demographics
NPI:1942212345
Name:RODD AKING MD LLC
Entity Type:Organization
Organization Name:RODD AKING MD LLC
Other - Org Name:TRINITY INTEGRATED MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODD
Authorized Official - Middle Name:
Authorized Official - Last Name:AKING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-873-0112
Mailing Address - Street 1:PO BOX 12170
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-2170
Mailing Address - Country:US
Mailing Address - Phone:623-873-0112
Mailing Address - Fax:623-873-1370
Practice Address - Street 1:5251 W CAMPBELL AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1718
Practice Address - Country:US
Practice Address - Phone:623-873-0112
Practice Address - Fax:623-873-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZL-1286974-7OtherCORPORATION/LLC NUMBER
AZH98416Medicare UPIN