The Trident Pacific Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

THE TRIDENT PACIFIC CORPORATION

Practice address

8001 Youree Dr Ste 550
Shreveport, LA 71115-2325

Phone

(318) 212-3740

NPI assigned

Oct 4, 2007

Last updated

Oct 4, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Glenda Moreno

Title

Office Manager

Phone

(318) 212-3740

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1225226194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5455",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711355455",
            "telephone_number": "318-212-3740",
            "fax_number": "318-212-3758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR STE 550",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152325",
            "telephone_number": "318-212-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE TRIDENT PACIFIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-212-3740",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.