Provider Demographics
NPI:1720308604
Name:TRINITY HEALTH CLINIC
Entity Type:Organization
Organization Name:TRINITY HEALTH CLINIC
Other - Org Name:BORDERS-BLACKWELL MEDICAL & WELLNESS CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-588-3707
Mailing Address - Street 1:548 ROSEMARY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2075
Mailing Address - Country:US
Mailing Address - Phone:662-588-3707
Mailing Address - Fax:
Practice Address - Street 1:548 ROSEMARY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2075
Practice Address - Country:US
Practice Address - Phone:662-588-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BORDERS-BLACKWELL MEDICAL & WELLNESS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center