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General NPI Number Information
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NPI Number | 1104551043
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTHCARE UT, PC
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 3720 W 800 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-4565
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Country | US
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Telephone | 801-515-7266
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 N MAYFAIR AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65803-5084
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Country | US
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Telephone | 417-799-8901
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ABRAHAM
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Credential | MD
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Telephone | 417-799-8901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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