Provider Demographics
NPI:1851852297
Name:TRINITY HERITAGE PLLC
Entity type:Organization
Organization Name:TRINITY HERITAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NWILOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-966-3226
Mailing Address - Street 1:PO BOX 963207
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-3207
Mailing Address - Country:US
Mailing Address - Phone:817-966-3226
Mailing Address - Fax:
Practice Address - Street 1:2204 JOE BATTLE BLVD # D203
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4660
Practice Address - Country:US
Practice Address - Phone:817-966-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851338032OtherINDIVIDUAL NPI