Basic Information
| Provider Information | |||||||||
| NPI: | 1558681395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRINIDAD ORTHOPAEDICS AND SPORTSMEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 GREENWELL AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452385302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573960 | ||||||||
| FaxNumber: | 5135573506 | ||||||||
| Practice Location | |||||||||
| Address1: | 1729 KINNEYS LANE | ||||||||
| Address2: | SUITE-102 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456623166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403510980 | ||||||||
| FaxNumber: | 7403510021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | TRINIDAD | ||||||||
| AuthorizedOfficialFirstName: | GERARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7403510980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LF0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207XX0005X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3052940 | 05 | OH | MEDICAID |