Provider Demographics
NPI:1639617038
Name:TRINITY FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:TRINITY FAMILY MEDICAL CLINIC
Other - Org Name:TRINITY FAMILY MEDICAL CLINIC PS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GURAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-881-1844
Mailing Address - Street 1:610 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5908
Mailing Address - Country:US
Mailing Address - Phone:855-621-8250
Mailing Address - Fax:
Practice Address - Street 1:610 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-881-1844
Practice Address - Fax:253-881-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty