Healthcare Provider Details

I. General information

NPI: 1134184583
Provider Name (Legal Business Name): TRINITY HEALTH CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W WILSON AVE
MOORESVILLE NC
28117-8811
US

IV. Provider business mailing address

930 W WILSON AVE
MOORESVILLE NC
28117-8811
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-7500
  • Fax: 704-799-2613
Mailing address:
  • Phone: 704-663-7500
  • Fax: 704-799-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82291
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82291
License Number StateNC

VIII. Authorized Official

Name: DR. ANTHONY WAYNE MACASIEB
Title or Position: DOCTOR
Credential: MD
Phone: 704-663-7500