Healthcare Provider Details

I. General information

NPI: 1740534262
Provider Name (Legal Business Name): TRINITY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE POPE MEDICAL PLAZA
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

550 POPE AVE POPE MEDICAL PLAZA
WINTER HAVEN FL
33881
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2144
  • Fax: 863-293-3732
Mailing address:
  • Phone: 863-293-2144
  • Fax: 863-293-3732

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: KELLY A STANWOOD
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 863-401-8516