Provider Demographics
NPI:1033351226
Name:TRINCARE INC
Entity Type:Organization
Organization Name:TRINCARE INC
Other - Org Name:TRINCARE CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC CMC
Authorized Official - Phone:903-510-1113
Mailing Address - Street 1:PO BOX 130517
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0517
Mailing Address - Country:US
Mailing Address - Phone:903-510-1193
Mailing Address - Fax:
Practice Address - Street 1:620 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2041
Practice Address - Country:US
Practice Address - Phone:903-510-1193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTINOtherTRICARE
TXCL1071Medicare Oscar/Certification