| Trinity Doctors Group Pa | |
|
8133 State Road 54 New Port Richey FL 34655-3000 | |
| (727) 372-3750 | |
| (727) 372-3754 |
| Full Name | Trinity Doctors Group Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 8133 State Road 54, New Port Richey, Florida |
| Authorized Official Name and Position | John Dean Ibrahim (PRESIDENT) |
| Authorized Official Contact | 7273723750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Doctors Group Pa 8133 State Road 54 New Port Richey FL 34655-3000 Ph: (727) 372-3750 | Trinity Doctors Group Pa 8133 State Road 54 New Port Richey FL 34655-3000 Ph: (727) 372-3750 |
| NPI Number | 1952564726 |
|---|---|
| Provider Enumeration Date | 07/02/2008 |
| Last Update Date | 04/03/2019 |
| Medicare PECOS PAC ID | 9537220975 |
|---|---|
| Medicare Enrollment ID | O20081204000275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952564726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | ME101502 (Florida) | Primary |
| Provider Name | John Dean Ibrahim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669555470 PECOS PAC ID: 0648331082 Enrollment ID: I20081204000259 |
| Provider Name | Diana N Hatton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891357323 PECOS PAC ID: 3678802238 Enrollment ID: I20190906000840 |
| Provider Name | Ronald Brunk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215561238 PECOS PAC ID: 9739519547 Enrollment ID: I20200420000062 |
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