Provider Demographics
NPI:1760119440
Name:TRINITY SALEM FAMILY HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:TRINITY SALEM FAMILY HEALTH CLINIC PLLC
Other - Org Name:TRINITY SALEM FAMILY HEALTH CLINIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER., AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAMINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:972-666-8111
Mailing Address - Street 1:1007 LEGACY RANCH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1294
Mailing Address - Country:US
Mailing Address - Phone:972-666-8111
Mailing Address - Fax:
Practice Address - Street 1:1007 LEGACY RANCH RD STE 102
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1294
Practice Address - Country:US
Practice Address - Phone:336-341-9295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty