Provider Demographics
NPI:1760676613
Name:TRINITY CLINIC
Entity Type:Organization
Organization Name:TRINITY CLINIC
Other - Org Name:TRINITY CLINIC HENDERSON 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN CLINIC SUPPORT COORDINATO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CMC
Authorized Official - Phone:903-510-1113
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:511 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5985
Practice Address - Country:US
Practice Address - Phone:903-657-7583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-04
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177294901Medicaid
TX131500OtherSUPERIOR HEALTH
TX673883Medicare Oscar/Certification
TX131500OtherSUPERIOR HEALTH