Provider Demographics
NPI:1063801017
Name:TRITON INTEGRATED CARE PLLC
Entity type:Organization
Organization Name:TRITON INTEGRATED CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-917-2015
Mailing Address - Street 1:PO BOX 3412
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9412
Mailing Address - Country:US
Mailing Address - Phone:817-917-2015
Mailing Address - Fax:214-481-4179
Practice Address - Street 1:450 S DENTON TAP RD
Practice Address - Street 2:3412
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7101
Practice Address - Country:US
Practice Address - Phone:817-917-2015
Practice Address - Fax:214-481-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4906208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty