Provider Demographics
NPI:1013924133
Name:TRINITY DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:TRINITY DEVELOPMENT, LLC
Other - Org Name:SOUTH ALABAMA OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-393-5474
Mailing Address - Street 1:201 E WATTS ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1812
Mailing Address - Country:US
Mailing Address - Phone:334-393-5474
Mailing Address - Fax:334-393-7433
Practice Address - Street 1:201 E WATTS ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1812
Practice Address - Country:US
Practice Address - Phone:334-393-5474
Practice Address - Fax:334-393-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALU1601261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7523305OtherAETNA PROVIDER NO
ALASC0064CMedicaid
AL012237OtherBCBS AL PROVIDER NO
AL012237OtherBCBS AL PROVIDER NO
ALASC0064CMedicaid