Provider Demographics
NPI:1134184583
Name:TRINITY HEALTH CARE PA
Entity type:Organization
Organization Name:TRINITY HEALTH CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MACASIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-663-7500
Mailing Address - Street 1:930 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8811
Mailing Address - Country:US
Mailing Address - Phone:704-663-7500
Mailing Address - Fax:704-799-2613
Practice Address - Street 1:930 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8811
Practice Address - Country:US
Practice Address - Phone:704-663-7500
Practice Address - Fax:704-799-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82291207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690228MMedicaid
NC690228MMedicaid