MEDICARE: FIRST TRINITY MISSIONARY BAPTIST CHURCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1104474329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST TRINITY MISSIONARY BAPTIST CHURCH

Provider Business Mailing Address
First Line	:	1226 BEACH ST
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502
Country	:	US
Telephone Number	:	313-443-7136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 BEACH ST
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502
Country	:	US
Telephone Number	:	313-443-7136
Fax Number	:

Authorized Official
Title or Position	:	PASTOR
Name	:	MR. EZRA LEE TILLMAN JR.
Credential	:	B.R.E, M.M.N
Telephone Number	:	313-443-7136

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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Directions to “FIRST TRINITY MISSIONARY BAPTIST CHURCH ” Practice Location

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