Provider Demographics
NPI:1518543297
Name:TRIDENT MEDICAL CONCIERGE INC
Entity type:Organization
Organization Name:TRIDENT MEDICAL CONCIERGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-595-1958
Mailing Address - Street 1:6 HALSEY RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3316
Mailing Address - Country:US
Mailing Address - Phone:617-595-1958
Mailing Address - Fax:
Practice Address - Street 1:6 HALSEY RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3316
Practice Address - Country:US
Practice Address - Phone:617-595-1958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care