MEDICARE: TRINITY COMMUNITY MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WC1500X	Community Health Registered Nurse
2	163WG0000X	General Practice Registered Nurse
3	207Q00000X	Family Medicine Physician
4	207QA0000X	Adolescent Medicine (Family Medicine) Physician
5	101YM0800X	Mental Health Counselor
6	104100000X	Social Worker
7	363LP2300X	Primary Care Nurse Practitioner
8	207QA0505X	Adult Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01	OTHER	LA	COMMERCIAL INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720755895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY COMMUNITY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	8451 HIGHWAY 23 STE 1
Second Line	:
City	:	BELLE CHASSE
State	:	LA
Zip	:	70037-2594
Country	:	US
Telephone Number	:	504-417-3728
Fax Number	:

Provider Business Practice Location Address
First Line	:	8451 HIGHWAY 23 STE 1
Second Line	:
City	:	BELLE CHASSE
State	:	LA
Zip	:	70037-2594
Country	:	US
Telephone Number	:	504-417-3728
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MS. MARY E MARTINEZ
Credential	:
Telephone Number	:	504-417-3728

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	01/11/2022

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Directions to “TRINITY COMMUNITY MEDICAL CLINIC ” Practice Location

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