Healthcare Provider Details

I. General information

NPI: 1568028173
Provider Name (Legal Business Name): TRINITY SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 ALEXANDRIA ROW
O FALLON MO
63368-8558
US

IV. Provider business mailing address

2052 ALEXANDRIA ROW
O FALLON MO
63368-8558
US

V. Phone/Fax

Practice location:
  • Phone: 618-225-7689
  • Fax:
Mailing address:
  • Phone: 618-225-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: DARLA PARTAIN
Title or Position: BILLING MANAGER
Credential:
Phone: 314-487-7215