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Organization
TRIDENT MEDICAL GROUP PA
Active
Organization
TRIDENT MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVION SMITH (DIRECTOR, PAYER CONTRACTING)
(424) 326-8711
Entity
Organization
Contact information
Practice address
382 NE 191ST ST, PMB 75481, MIAMI, FL 33179-3899
(855) 770-7771
Mailing address
1256 FOLSOM ST, SAN FRANCISCO, CA 94103-3817
(310) 626-0149
(855) 836-2741
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
NULL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
NULL
2086S0129X
Vascular Surgery Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
213EP0504X
Public Medicine Podiatrist
Primary
—
NULL
213EP0504X
Public Medicine Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Enumeration date
09/30/2021
Last updated
11/14/2022
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