| Trident Primary & Preventative Care | |
|
800 E Broward Blvd Ste 400 Fort Lauderdale FL 33301-2033 | |
| (954) 451-5454 | |
| Not Available |
| Full Name | Trident Primary & Preventative Care |
|---|---|
| Speciality | Family Medicine |
| Location | 800 E Broward Blvd Ste 400, Fort Lauderdale, Florida |
| Authorized Official Name and Position | John Poulos (OWNER) |
| Authorized Official Contact | 9544515454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trident Primary & Preventative Care 800 E Broward Blvd Ste 400 Fort Lauderdale FL 33301-2033 Ph: (954) 451-5454 | Trident Primary & Preventative Care 800 E Broward Blvd Ste 400 Fort Lauderdale FL 33301-2033 Ph: (954) 451-5454 |
| NPI Number | 1023574696 |
|---|---|
| Provider Enumeration Date | 02/19/2019 |
| Last Update Date | 08/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023574696 | NPI | - | NPPES |
| 1750407086 | Medicaid | FL | |
| 1750716387 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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