Provider Demographics
NPI:1427424183
Name:TREK MEDICAL, LLC
Entity type:Organization
Organization Name:TREK MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBUNARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-580-6700
Mailing Address - Street 1:5895 WINDWARD PARKWAY SUITE 150
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:678-580-6700
Mailing Address - Fax:770-817-9201
Practice Address - Street 1:5895 WINDWARD PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-580-6700
Practice Address - Fax:770-817-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder