Provider Demographics
NPI:1730958067
Name:TRILLIUM SURGERY LLC
Entity type:Organization
Organization Name:TRILLIUM SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-729-8483
Mailing Address - Street 1:680 BUCKLES CT N STE 2D
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6924
Mailing Address - Country:US
Mailing Address - Phone:614-729-8483
Mailing Address - Fax:
Practice Address - Street 1:680 BUCKLES CT N
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6924
Practice Address - Country:US
Practice Address - Phone:614-729-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical