Healthcare Provider Details
I. General information
NPI: 1508048596
Provider Name (Legal Business Name): TRENTON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/30/2007
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
103 U.S. HIGHWAY 27 SW
BRANFORD FL
32008-3048
US
IV. Provider business mailing address
23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US
V. Phone/Fax
- Phone: 386-935-3090
- Fax: 386-935-3198
- Phone: 386-454-0698
- Fax: 386-454-0690
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QF0400X |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ANITA
H.
REMBERT
Title or Position: CEO
Credential:
Phone: 386-454-0698