=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093771271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 LANGHORNE NEWTOWN RD
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-710-5092
-----------------------------------------------------
Fax | 215-710-6873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 UNIVERSITY DRIVE SUITE 300
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-343-2654
-----------------------------------------------------
Fax | 215-710-5181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, FINANCE AND CFO
-----------------------------------------------------
Name | KIMBERLY A CUMMINGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-710-2508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0102X
-----------------------------------------------------
Taxonomy Name | Surgical Critical Care Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2086S0127X
-----------------------------------------------------
Taxonomy Name | Trauma Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------