Organization
TRINITY CLINIC
Active
Parent organization
TRINITY CLNIC
Other names
Trinity Clinic Reference Laboratory
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRINITY CLNIC
Authorized official
MARY ANN HARRISON CPC CMC (PROVIDER ENROLLMENT COORDINATOR)
(903) 510-1113
Entity
Organization
Contact information
Practice address
3200 TROUP HWY, STE 110, TYLER, TX 75701-8359
(903) 510-1125
Mailing address
PO BOX 5500, TYLER, TX 75712-5500
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025522601
—
TX
01
—
H0CL831301
BCBS OF TEXAS
TX
Enumeration date
04/16/2007
Last updated
06/30/2009
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