| Trinity Health Care Pa | |
|
930 W Wilson Ave Mooresville NC 28117-8811 | |
| (704) 663-7500 | |
| (704) 799-2613 |
| Full Name | Trinity Health Care Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 930 W Wilson Ave, Mooresville, North Carolina |
| Authorized Official Name and Position | Anthony Wayne Macasieb (DOCTOR) |
| Authorized Official Contact | 7046637500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Health Care Pa 930 W Wilson Ave Mooresville NC 28117-8811 Ph: (704) 663-7500 | Trinity Health Care Pa 930 W Wilson Ave Mooresville NC 28117-8811 Ph: (704) 663-7500 |
| NPI Number | 1134184583 |
|---|---|
| Provider Enumeration Date | 04/19/2006 |
| Last Update Date | 03/24/2015 |
| Medicare PECOS PAC ID | 6608817416 |
|---|---|
| Medicare Enrollment ID | O20050520000882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134184583 | NPI | - | NPPES |
| 690228M | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 82291 (North Carolina) | Secondary |
| 207R00000X | Internal Medicine | 82291 (North Carolina) | Primary |
| Provider Name | Yvette-marie C Pellegrino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578536504 PECOS PAC ID: 5193746519 Enrollment ID: I20051213000892 |
| Provider Name | Beverly J Lessane |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740251875 PECOS PAC ID: 5597763821 Enrollment ID: I20061121000582 |
| Provider Name | Anthony W Macasieb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154325660 PECOS PAC ID: 9234170044 Enrollment ID: I20100824001043 |
| Provider Name | Christine Trinidad Lomboy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649447194 PECOS PAC ID: 8628082567 Enrollment ID: I20101228000898 |
| Provider Name | Smitha R Pasula |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063707354 PECOS PAC ID: 9335310598 Enrollment ID: I20110919000767 |
| Provider Name | Heather Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740683481 PECOS PAC ID: 0648592071 Enrollment ID: I20141213000038 |
| Provider Name | Jasmine A Huskey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437698057 PECOS PAC ID: 5193002194 Enrollment ID: I20170428001827 |
| Provider Name | Victoria Rebeca Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639895709 PECOS PAC ID: 3870958549 Enrollment ID: I20230502002139 |
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