CHRISTUS TRINITY CLINIC

Provider Demographics

• NPI: 1285684225
• Name: CHRISTUS TRINITY CLINIC
• Entity Type: Organization
• Organization Name: CHRISTUS TRINITY CLINIC
• Other - Org Name: CHRISTUS TRINITY CLINIC
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: ROBERT
• Authorized Official - Last Name: KARL
• Authorized Official - Phone: 469-282-2611
• Mailing Address - Street 1: PO BOX 846098
• Mailing Address - City: DALLAS
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75284-6098
• Mailing Address - Country: US
• Mailing Address - Phone: 903-324-6450
• Practice Address - Street 1: 520 DOUGLAS BLVD
• Practice Address - City: TYLER
• Practice Address - State: TX
• Practice Address - Zip Code: 75702-8307
• Practice Address - Country: US
• Practice Address - Phone: 903-315-4119
• Practice Address - Fax: 903-525-1566
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-11
• Last Update Date: 2024-04-12

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	207L00000X	Allopathic & Osteopathic Physicians	Anesthesiology		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207QA0505X	Allopathic & Osteopathic Physicians	Family Medicine	Adult Medicine	Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RE0101X	Allopathic & Osteopathic Physicians	Internal Medicine	Endocrinology, Diabetes & Metabolism	Group - Multi-Specialty
No	207RG0100X	Allopathic & Osteopathic Physicians	Internal Medicine	Gastroenterology	Group - Multi-Specialty
No	207RR0500X	Allopathic & Osteopathic Physicians	Internal Medicine	Rheumatology	Group - Multi-Specialty
No	207RS0012X	Allopathic & Osteopathic Physicians	Internal Medicine	Sleep Medicine	Group - Multi-Specialty
No	207SG0201X	Allopathic & Osteopathic Physicians	Medical Genetics	Clinical Genetics (M.D.)	Group - Multi-Specialty
No	207T00000X	Allopathic & Osteopathic Physicians	Neurological Surgery		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	138737529	Medicaid
TX	138737530	Medicaid
TX	141838601	Other	THSTEPS-WHITEHOUSE
TX	063685402	Medicaid
TX	138737528	Medicaid
TX	168206402	Medicaid
TX	138737521	Medicaid
TX	138737532	Medicaid
TX	138737522	Medicaid
TX	138737524	Medicaid
TX	138737510	Medicaid
TX	138737527	Medicaid
TX	138737506	Medicaid
TX	138737536	Medicaid
TX	141835201	Medicaid
TX	138737534	Medicaid
TX	138737535	Medicaid
TX	1091520016	Other	PALMETTO DME-KILGORE
TX	138737504	Medicaid
TX	138737511	Medicaid
TX	138737531	Medicaid
TX	138737533	Medicaid
TX	177294903	Medicaid
TX	138737529	Medicaid
TX	00T68U	Medicare Oscar/Certification
TX	CR1018	Medicare PIN
TX	CN5356	Medicare PIN
TX	CH5243	Medicare PIN
TX	00T72U	Medicare ID - Type Unspecified	LAKE P, LINDALE, FP'S GRO
TX	138737528	Medicaid
TX	138737527	Medicaid
TX	141835201	Medicaid
TX	138737511	Medicaid
TX	0071AU	Medicare Oscar/Certification
TX	DC5235	Medicare PIN
TX	00T69U	Medicare ID - Type Unspecified	SPECIALITY GROUP NUMBER
TX	00T68U	Medicare ID - Type Unspecified	ANESTHESIA GROUP NUMBER
TX	138737531	Medicaid
TX	138737521	Medicaid
TX	138737524	Medicaid
TX	063685402	Medicaid
TX	177294903	Medicaid
TX	CL8313	Medicare Oscar/Certification
TX	CN3629	Medicare PIN
TX	00T66U	Medicare ID - Type Unspecified	PEDI,CHILDRENS, ATHENS-PE
TX	138737510	Medicaid
TX	168206402	Medicaid
TX	0069AU	Medicare Oscar/Certification
TX	00T66U	Medicare Oscar/Certification
TX	CR1017	Medicare PIN