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General NPI Number Information
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NPI Number | 1144493107
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Entity Type | Organization
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Legal Business Name | TRINITY CLINIC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 866 E. LENNON DR STE 105
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City | EMORY
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State | TX
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Zip | 75440-3214
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Country | US
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Telephone | 903-473-3036
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Fax | 903-473-2007
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Provider Business Mailing Address
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Address Line | PO BOX 5500
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City | TYLER
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State | TX
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Zip | 75712-5500
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Country | US
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Telephone | 903-324-6400
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN CLINIC SUPPORT COORDINATO
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Name | MARY ANN HARRISON
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Credential | CPC CMC
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Telephone | 903-510-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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