Healthcare Provider Details

I. General information

NPI: 1982968541
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF TRINITY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 MAPLE CREEK DR SUITE 103
TRINITY FL
34655-4418
US

IV. Provider business mailing address

3152 LITTLE RD SUITE 311
TRINITY FL
34655-1864
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0400
  • Fax: 727-372-0403
Mailing address:
  • Phone: 727-372-0400
  • Fax: 727-372-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH GREGORY CHISHOLM
Title or Position: DIRECTOR
Credential: MD
Phone: 727-372-0400