| Trident Health Center | |
|
20340 N Lake Pleasant Rd Ste 109 Peoria AZ 85382-9713 | |
| (623) 299-9988 | |
| Not Available |
| Full Name | Trident Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 20340 N Lake Pleasant Rd Ste 109, Peoria, Arizona |
| Authorized Official Name and Position | Arvind Mahadevan (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4802412034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trident Health Center 20340 N Lake Pleasant Rd Suite 109 Peoria AZ 85382-9714 Ph: (623) 299-9988 | Trident Health Center 20340 N Lake Pleasant Rd Ste 109 Peoria AZ 85382-9713 Ph: (623) 299-9988 |
| NPI Number | 1902204191 |
|---|---|
| Provider Enumeration Date | 12/20/2014 |
| Last Update Date | 10/27/2016 |
| Medicare PECOS PAC ID | 7719260389 |
|---|---|
| Medicare Enrollment ID | O20211001001983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902204191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 40752 (Arizona) | Primary |
| Provider Name | Arvind M Mahadevan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114199148 PECOS PAC ID: 6901965961 Enrollment ID: I20081105000310 |
| Provider Name | Tiana S King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821799974 PECOS PAC ID: 8921463761 Enrollment ID: I20230428002711 |
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