Basic Information
| Provider Information | |||||||||
| NPI: | 1700858818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRINITY MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 FORT SANDERS WEST BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655390270 | ||||||||
| FaxNumber: | 8655396998 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 FORT SANDERS WEST BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655390270 | ||||||||
| FaxNumber: | 8655396998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | LEAH | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8655390270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20818 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34640 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 28506 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 28506 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | 20447 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3719925 | 05 | TN | MEDICAID |