Healthcare Provider Details

I. General information

NPI: 1942250998
Provider Name (Legal Business Name): TRINITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 TURTLE CREEK DR
TYLER TX
75701-1833
US

IV. Provider business mailing address

PO BOX 5500
TYLER TX
75712
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-3942
  • Fax:
Mailing address:
  • Phone: 903-324-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN HARRISON
Title or Position: PHYSICIAN CLINIC SUPPORT COORDINATO
Credential: CPC, CMC
Phone: 903-510-1113