Provider Demographics
NPI:1477019099
Name:TRINITY FAMILY MEDICAL, PLLC
Entity Type:Organization
Organization Name:TRINITY FAMILY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-422-8811
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2069
Mailing Address - Country:US
Mailing Address - Phone:281-422-8811
Mailing Address - Fax:281-422-5372
Practice Address - Street 1:507 ROLLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4036
Practice Address - Country:US
Practice Address - Phone:281-422-8811
Practice Address - Fax:281-422-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center