Organization
TRINITY CLINIC
Active
Parent organization
TRINITY CLINIC
Other names
Trinity Clinic Emory
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRINITY CLINIC
Authorized official
MARY ANN HARRISON CPC CMC (PROVIDER ENROLLMENT COORDINATOR)
(903) 510-1113
Entity
Organization
Contact information
Practice address
886 E LENNON DR, STE 105, EMORY, TX 75440-3214
(903) 473-3036
(903) 473-2007
Mailing address
PO BOX 840698, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030PS
BCBS GROUP
TX
05
—
091888002
—
TX
05
—
137940601
—
TX
05
—
177294904
—
TX
05
—
184554701
—
TX
01
—
CP0098
RAILROAD MEDICARE
TX
Enumeration date
03/19/2007
Last updated
04/20/2015
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