Provider Demographics
NPI:1982968541
Name:SURGICAL SPECIALISTS OF TRINITY, PA
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF TRINITY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-372-0400
Mailing Address - Street 1:3152 LITTLE RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1864
Mailing Address - Country:US
Mailing Address - Phone:727-372-0400
Mailing Address - Fax:727-372-0403
Practice Address - Street 1:10751 MAPLE CREEK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4418
Practice Address - Country:US
Practice Address - Phone:727-372-0400
Practice Address - Fax:727-372-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty