Healthcare Provider Details

I. General information

NPI: 1740947803
Provider Name (Legal Business Name): CHRISTOPHER TRENUM MILLS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MCCREIGHT AVE STE 150
SPRINGFIELD OH
45504-1890
US

IV. Provider business mailing address

100 W MCCREIGHT AVE STE 150
SPRINGFIELD OH
45504-1890
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-1404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1167489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: