Provider Demographics
NPI:1003082769
Name:TRINITY URGENT CARE & FAMILY PRACTICE, PLLC
Entity Type:Organization
Organization Name:TRINITY URGENT CARE & FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/MSN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:910-775-9027
Mailing Address - Street 1:923 W 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9684
Mailing Address - Country:US
Mailing Address - Phone:910-775-9027
Mailing Address - Fax:910-775-9131
Practice Address - Street 1:923 W 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9684
Practice Address - Country:US
Practice Address - Phone:910-775-9027
Practice Address - Fax:910-775-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201409261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004413Medicaid
NC7004413Medicaid