MEDICARE: TRINITY CLINIC

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	261Q00000X	Clinic/Center
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356391734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 5500
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75712-5500
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 E HOUSTON ST
Second Line	:	STE 530
City	:	TYLER
State	:	TX
Zip	:	75702-8366
Country	:	US
Telephone Number	:	903-592-7393
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN CLINICSUPPORT COORDINATOR
Name	:	MARY ANN HARRISON
Credential	:
Telephone Number	:	903-510-1113

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	09/17/2008

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Directions to “TRINITY CLINIC ” Practice Location

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