1316789506 NPI number — TRINITY WEST

Table of content: (NPI 1316789506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316789506 NPI number — TRINITY WEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY WEST
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:
Provider Other Organization Name Type Code:
6
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:
1316789506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 SUMMIT AVENUE
Provider Second Line Business Mailing Address:
MSO PHYSICIAN BILLING
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-283-7776
Provider Business Mailing Address Fax Number:
740-283-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82424 CADIZ JEWETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADIZ
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43907-9427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-320-4048
Provider Business Practice Location Address Fax Number:
740-652-6477
Provider Enumeration Date:
06/10/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WERKIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
740-264-8110

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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