Provider Demographics
NPI:1689462608
Name:TRINITY HEALTHCARE PRACTICE
Entity type:Organization
Organization Name:TRINITY HEALTHCARE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOND
Authorized Official - Suffix:
Authorized Official - Credentials:CANP
Authorized Official - Phone:217-521-6684
Mailing Address - Street 1:2810 FRANK SCOTT PKWY W STE 708
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5007
Mailing Address - Country:US
Mailing Address - Phone:314-252-8704
Mailing Address - Fax:618-416-1252
Practice Address - Street 1:2810 FRANK SCOTT PKWY W STE 708
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5007
Practice Address - Country:US
Practice Address - Phone:314-252-8704
Practice Address - Fax:618-416-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty