Provider Demographics
NPI:1235401084
Name:TRINITY MOBILE HEALTH CLINIC
Entity Type:Organization
Organization Name:TRINITY MOBILE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-435-7800
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:MS
Mailing Address - Zip Code:39743-0095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15865 HIGHWAY 14 WEST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2453
Practice Address - Country:US
Practice Address - Phone:662-435-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY SPECIALTY CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-08
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QR1300X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health