Healthcare Provider Details

I. General information

NPI: 1013387075
Provider Name (Legal Business Name): TRINA HEALTH OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10908 N WESTERN AVE
OKLAHOMA CITY OK
73114-7068
US

IV. Provider business mailing address

10908 N WESTERN AVE
OKLAHOMA CITY OK
73114-7068
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-8450
  • Fax:
Mailing address:
  • Phone: 405-603-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number15256
License Number StateOK

VIII. Authorized Official

Name: WILLIAM HOLLAWAY
Title or Position: DIRECTOR
Credential:
Phone: 405-603-8450