Healthcare Provider Details

I. General information

NPI: 1558681395
Provider Name (Legal Business Name): TRINIDAD ORTHOPAEDICS AND SPORTSMEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 KINNEYS LANE SUITE-102
PORTSMOUTH OH
45662-3166
US

IV. Provider business mailing address

415 GREENWELL AVE
CINCINNATI OH
45238-5302
US

V. Phone/Fax

Practice location:
  • Phone: 740-351-0980
  • Fax: 740-351-0021
Mailing address:
  • Phone: 513-557-3960
  • Fax: 513-557-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: GERARDO TRINIDAD
Title or Position: PRESIDENT
Credential: MD
Phone: 740-351-0980