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General NPI Number Information
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NPI Number | 1285684258
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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 | 05/11/2006
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 500 N. MARSHALL
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City | HENDERSON
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State | TN
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Zip | 75652
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Country | US
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Telephone | 903-657-1653
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Fax |
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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
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Country | US
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Telephone | 903-324-6450
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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