Provider Demographics
NPI:1710929310
Name:TRINITY PAIN CLINIC, P.A.
Entity Type:Organization
Organization Name:TRINITY PAIN CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-898-7527
Mailing Address - Street 1:PO BOX 320759
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0759
Mailing Address - Country:US
Mailing Address - Phone:601-420-2040
Mailing Address - Fax:601-420-2050
Practice Address - Street 1:1307 AIRPORT RD N
Practice Address - Street 2:SUITE 2A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8897
Practice Address - Country:US
Practice Address - Phone:601-420-2040
Practice Address - Fax:601-420-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain