MEDICARE: TRIFECTA HEALTHCARE SERVICES, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WP0000X	Pain Management Registered Nurse
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QP2000X	Physical Therapy Clinic/Center
4	261QP2300X	Primary Care Clinic/Center
5	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1255086583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIFECTA HEALTHCARE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	5911 MONTICELLO DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1940
Country	:	US
Telephone Number	:	443-902-8816
Fax Number	:

Provider Business Practice Location Address
First Line	:	5911 MONTICELLO DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1940
Country	:	US
Telephone Number	:	334-676-2797
Fax Number	:	334-323-7148

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JASMINE GRAHAM
Credential	:
Telephone Number	:	334-676-2797

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	07/08/2024

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