1093771271 NPI number — TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

Table of content: (NPI 1093771271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093771271 NPI number — TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
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:
THMA MG TRAUMA SERVICE LANGHORNE
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:
1093771271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-710-5522
Provider Business Mailing Address Fax Number:
215-710-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 LANGHORNE NEWTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-710-5092
Provider Business Practice Location Address Fax Number:
215-710-6873
Provider Enumeration Date:
04/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
REGIONAL VP
Authorized Official Telephone Number:
215-710-6542

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007497370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1458100 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".