Healthcare Provider Details

I. General information

NPI: 1730774183
Provider Name (Legal Business Name): TRINITY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PROSPECT AVE
ESTES PARK CO
80517-6312
US

IV. Provider business mailing address

PO BOX 1230
MONUMENT CO
80132-1230
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J RYAN
Title or Position: SOLE OWNER
Credential: MD
Phone: 805-325-9385