1336399260 NPI number — TRENTON MEDICAL CENTER INC

Table of content: (NPI 1336399260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336399260 NPI number — TRENTON MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRENTON MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PALMS MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336399260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23343 NW COUNTY ROAD 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32643-9669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-454-0698
Provider Business Mailing Address Fax Number:
386-454-0690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 N MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 1 AND 2
Provider Business Practice Location Address City Name:
CHIEFLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32626-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-493-7274
Provider Business Practice Location Address Fax Number:
352-493-9290
Provider Enumeration Date:
09/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
REMBERT
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
386-454-0698

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029506009 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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