MEDICARE: TRINITY GERIATRICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1134691744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY GERIATRICS PA

Provider Business Mailing Address
First Line	:	11901 SHADOW CREEK PKWY STE 111
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	281-760-1971
Fax Number	:	888-257-3780

Provider Business Practice Location Address
First Line	:	11901 SHADOW CREEK PKWY STE 111
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	281-760-1971
Fax Number	:	888-257-3780

Authorized Official
Title or Position	:	CEO
Name	:	DR. DANIEL OBI-OFODILE
Credential	:	MD
Telephone Number	:	281-760-1971

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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