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General NPI Number Information
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NPI Number | 1720755895
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Entity Type | Organization
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Legal Business Name | TRINITY COMMUNITY MEDICAL CLINIC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 8451 HIGHWAY 23 STE 1
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City | BELLE CHASSE
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State | LA
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Zip | 70037-2594
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Country | US
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Telephone | 504-417-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 8451 HIGHWAY 23 STE 1
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City | BELLE CHASSE
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State | LA
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Zip | 70037-2594
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Country | US
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Telephone | 504-417-3728
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | MS. MARY E MARTINEZ
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Credential |
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Telephone | 504-417-3728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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