Basic Information
| Provider Information | |||||||||
| NPI: | 1861694531 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRENTON MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PALMS MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23343 NW COUNTY ROAD 236 | ||||||||
| Address2: | |||||||||
| City: | HIGH SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326439669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864540698 | ||||||||
| FaxNumber: | 3864540690 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326194713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524632374 | ||||||||
| FaxNumber: | 3524632726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REMBERT | ||||||||
| AuthorizedOfficialFirstName: | ANITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3864540698 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | Y | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 025369300 | 05 | FL | MEDICAID |