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NPI Code Detail

MEDICARE: TRINITY PROCARE

MEDICARE: TRINITY PROCARE
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
1103T00000XPsychologist102091CA
2175L00000XHomeopath102091CA
3251E00000XHome Health Agency102091CA
4208100000XPhysical Medicine & Rehabilitation PhysicianH-102091CA

General Provider Information

NPI Number : 1487881561
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRINITY PROCARE
Provider Business Mailing Address
First Line : 2752 S STEWART AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-3859
Country : US
Telephone Number : 602-531-1658
Fax Number :
Provider Business Practice Location Address
First Line : 6930 N POLARIS PL
Second Line :
City : TUCSON
State : AZ
Zip : 85741-2435
Country : US
Telephone Number : 928-273-7501
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JASON COREY BULLARD
Credential : M.D.
Telephone Number : 928-273-7501
Provider Enumeration Date : 06/16/2009
Last Update Date : 06/16/2009

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Directions to “TRINITY PROCARE ” Practice Location

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