Provider Demographics
NPI:1568797223
Name:TRINITY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:TRINITY HEALTH CARE, LLC
Other - Org Name:SOUTH MAIN FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOUK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-256-3858
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-0463
Mailing Address - Country:US
Mailing Address - Phone:662-256-3858
Mailing Address - Fax:662-256-3838
Practice Address - Street 1:200 MAIN ST S
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-4218
Practice Address - Country:US
Practice Address - Phone:662-256-3858
Practice Address - Fax:662-256-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR797975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09657361Medicaid
MS09657361Medicaid