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General NPI Number Information
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NPI Number | 1982968541
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS OF TRINITY, PA
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 10751 MAPLE CREEK DR SUITE 103
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City | TRINITY
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State | FL
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Zip | 34655-4418
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Country | US
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Telephone | 727-372-0400
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Fax | 727-372-0403
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Provider Business Mailing Address
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Address Line | 3152 LITTLE RD SUITE 311
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City | TRINITY
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State | FL
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Zip | 34655-1864
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Country | US
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Telephone | 727-372-0400
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Fax | 727-372-0403
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KEITH GREGORY CHISHOLM
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Credential | MD
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Telephone | 727-372-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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