MEDICARE: TRINA BIVENS MD PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	K3557	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0016MQ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1578740486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINA BIVENS MD PA

Provider Business Mailing Address
First Line	:	7515 GREENVILLE AVE STE 503
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3865
Country	:	US
Telephone Number	:	214-345-5765
Fax Number	:	214-345-5767

Provider Business Practice Location Address
First Line	:	7515 GREENVILLE AVE STE 503
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231
Country	:	US
Telephone Number	:	214-345-5165
Fax Number	:	214-345-5767

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MS. MELISSA LASHAWN BOYD
Credential	:
Telephone Number	:	214-345-6256

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	02/15/2008

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Directions to “TRINA BIVENS MD PA ” Practice Location

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