Provider Demographics
NPI:1013156629
Name:TRINITY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:TRINITY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-434-0200
Mailing Address - Street 1:832 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2334
Mailing Address - Country:US
Mailing Address - Phone:731-424-0200
Mailing Address - Fax:731-434-0203
Practice Address - Street 1:832 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2334
Practice Address - Country:US
Practice Address - Phone:731-434-0200
Practice Address - Fax:731-434-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
TNAPN0000007669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341736OtherMEDICARE PTAN