=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710533534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY PRIMARY CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2019
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3185 W ATLANTIC BLVD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-777-8800
-----------------------------------------------------
Fax | 754-220-8929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3185 W ATLANTIC BLVD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-777-8800
-----------------------------------------------------
Fax | 954-220-8929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEAN F RODNEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-777-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------