Healthcare Provider Details

I. General information

NPI: 1679844864
Provider Name (Legal Business Name): TRINITY PAIN CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD SUITE 500
FLOWOOD MS
39232-8205
US

IV. Provider business mailing address

PO BOX 320759
FLOWOOD MS
39232-0759
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-2040
  • Fax: 601-420-3683
Mailing address:
  • Phone: 601-420-2040
  • Fax: 601-420-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number05337
License Number StateMS

VIII. Authorized Official

Name: REX WILLIAMS
Title or Position: MEMBER
Credential: MD
Phone: 601-420-2040