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General NPI Number Information
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NPI Number | 1215237839
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Entity Type | Organization
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Legal Business Name | TRIDENT MEDICAL MANAGEMENT, INC.
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 6131 US HIGHWAY 19
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2527
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Country | US
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Telephone | 727-842-6900
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Fax | 727-842-6902
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Provider Business Mailing Address
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Address Line | 6131 US HIGHWAY 19
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2527
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Country | US
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Telephone | 727-842-6900
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Fax | 727-842-6902
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AKINWUMI GAMMAL ALADESAWE
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Credential | M.D.
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Telephone | 727-842-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME112766
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | ME112766
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License Number State | FL
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