Provider Demographics
NPI:1508835794
Name:BRETT W. HANNA
Entity Type:Organization
Organization Name:BRETT W. HANNA
Other - Org Name:TRINITY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-594-5460
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:110 E. BRANTLEY, STE. 6
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-2177
Mailing Address - Country:US
Mailing Address - Phone:936-594-5460
Mailing Address - Fax:936-594-9082
Practice Address - Street 1:110 E BRANTLEY RD STE 6
Practice Address - Street 2:BOX 2177
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-2177
Practice Address - Country:US
Practice Address - Phone:936-594-5460
Practice Address - Fax:936-594-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011023101Medicaid
TX016993001Medicaid
TX530548OtherBLUE CROSS BLUE SHIELD TX
TX1293330001Medicare NSC