# TRIDENT MEDICAL GROUP PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295407922
- **Authorized official:** DEVION SMITH (DIRECTOR, PAYER CONTRACTING)
- **Authorized official phone:** (424) 326-8711

## Contact information

- **Practice address:** 382 NE 191ST ST, PMB 75481, MIAMI, FL 33179-3899
- **Practice address phone:** (855) 770-7771
- **Mailing address:** 1256 FOLSOM ST, SAN FRANCISCO, CA 94103-3817
- **Mailing address phone:** (310) 626-0149
- **Mailing address fax:** (855) 836-2741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 213EP0504X | Public Medicine Podiatrist | — | — | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 09/30/2021
- **Last updated:** 11/14/2022