TRIDENT CLINICAL PLLC (NPI# 1902204191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902204191 |
| Entity Type | Organization |
| Organization Name | TRIDENT CLINICAL PLLC |
| Other Organization Name | TRIDENT HEALTH CENTER |
| Practice Address |
20340 N Lake Pleasant Rd Ste 109 Peoria AZ 85382-9713 |
| Mailing Address |
20340 N Lake Pleasant Rd Suite 109 Peoria AZ 85382-9714 |
| Practice Telephone | 6232999988 |
| Mailing Telephone | 6232999988 |
| Enumeration Date | 2014-12-20 |
| Last Update Date | 2016-10-27 |
| Authorized Official Name | DR. ARVIND MAHADEVAN (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 4802412034 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
40752 | AZ | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| TRIDENT HEALTH CENTER | Doing Business As Name - Organization |
| Street Address |
20340 N LAKE PLEASANT RD STE 109 |
| City | PEORIA |
| State | AZ |
| Zip Code | 85382-9713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063908697 | Krysten Begley | Nurse Practitioner | 20340 N Lake Pleasant Rd Ste 109, Peoria, AZ 85382-9713 | 2018-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435146 | Arizona Ot Solutions LLC | Occupational Therapist | 7450 W. Karen Lee Lane, Peoria, AZ 85382 | 2020-10-21 |
| 1497380604 | Idream Psychiatry | Psychiatry & Neurology | 8194 West Deer Valley Rd, 106-516, Peoria, AZ 85382 | 2020-03-08 |
| 1770137648 | Stefan Cseh | Occupational Therapy Assistant | 8765 W Keiton Lane #116, Peona, AZ 85382 | 2019-07-30 |
| 1174177422 | Assyrian Cultural Foundation of Arizona | Homemaker | 9163 West Union Hills Drive, Suite 114 and 115, Peoria, AZ 85382 | 2019-07-25 |
| 1073072765 | Darby Shipman | Physical Therapist | 8685 W. Union Hills Drive, Peoria, AZ 85382 | 2019-03-13 |
| 1811483480 | Kimberly Ann Cochran | Nurse Practitioner | 8194 W Deer Valley Rd Ste 106-516, Peoria, AZ 85382 | 2018-07-07 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1497258727 | Nkemdirim Obiora | Nurse Practitioner | 7853 West Lone Cactus Drive, Peoria, AZ 85382 | 2018-03-13 |
| 1851893721 | Alyssa Michelle Bauman | Registered Nurse | 20283 N Lake Pleasant Rd Ste 112, Peoria, AZ 85382 | 2018-03-06 |
| 1043767106 | Jason Mcaddley | Pharmacist | 9425 West Union Hills Drive, Peoria, AZ 85382 | 2016-09-07 |
| Find all providers in zip 85382 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043851793 | Honorhealth Medical Group, LLC | Clinic/Center | 10230 W Happy Valley Pkwy Ste 200, Peoria, AZ 85383-4255 | 2019-10-03 |
| 1427419894 | E&a Solutions | Clinic/Center | 24656 North Lake Pleasant Parkway, St 103-288, Peoria, AZ 85373 | 2016-03-14 |
| 1225382476 | Premiere Medical Care Pllc | Clinic/Center | 8914 N 91st Ave Ste 100a, Peoria, AZ 85345-8390 | 2012-11-08 |
| 1124252127 | Partners In Recovery, LLC | Clinic/Center | 14100 N 83rd Ave Ste 100150, Peoria, AZ 85381-5658 | 2009-05-06 |
| 1659409290 | Eagle Family Medicine Sc | Clinic/Center | 2809 W Willow Knolls Suite C, Peoria, IL 61614-8259 | 2007-03-02 |
| 1922646686 | Activate Healthcare - Peoria Public Schools Clinic | Clinic/Center | 1524 W Glen Ave, Peoria, IL 61614-4692 | 2019-12-12 |
| 1821550310 | Country Doctor Inc | Clinic/Center | 13260 N 94th Dr Ste 102, Peoria, AZ 85381-4242 | 2019-04-03 |
| 1285966242 | Sun City Medical Specialists Ltd | Clinic/Center | 13460 N 94th Dr, H-1, Peoria, AZ 85381-4835 | 2010-02-02 |
| 1194825190 | Thomas F Kouri Internal Medicine Inc | Clinic/Center | 5401 N Knoxville Ave, Peoria, IL 61614-5098 | 2006-09-22 |
| 1306890108 | Proctor Health Systems | Clinic/Center | 5401 N Knoxville Ave, Suite 300, Peoria, IL 61614-5098 | 2006-05-19 |
| Find all providers in PEORIA | ||||
Please comment or provide details below to improve the information on TRIDENT CLINICAL PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.