Provider Demographics
NPI:1902801913
Name:TRINITY ORTHOTICS INC
Entity Type:Organization
Organization Name:TRINITY ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-771-2603
Mailing Address - Street 1:230 NORTHLAND BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3600
Mailing Address - Country:US
Mailing Address - Phone:513-771-2603
Mailing Address - Fax:
Practice Address - Street 1:230 NORTHLAND BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3600
Practice Address - Country:US
Practice Address - Phone:513-771-2603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
OH5265100001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH82-00654OtherEVERCARE
KY90009598Medicaid
OH2519920Medicaid
OH000000359414OtherANTHEM BC/BS
OH000000359414OtherANTHEM BC/BS