1134138167 NPI number — DR. DAVID RUSSELL TRIGG MD

Table of content: DR. DAVID RUSSELL TRIGG MD (NPI 1134138167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134138167 NPI number — DR. DAVID RUSSELL TRIGG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIGG
Provider First Name:
DAVID
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIGG
Provider Other First Name:
DAVID
Provider Other Middle Name:
RUSSELL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134138167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 BROAD ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29150-4167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-773-5227
Provider Business Mailing Address Fax Number:
803-753-9312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-4167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-773-5227
Provider Business Practice Location Address Fax Number:
803-753-9312
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  18211 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18211 . This is a "STATE LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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