Organization
TRINITY CLINIC
Active
Parent organization
TRINITY CLINIC
Other names
Trinity Clinic Kilgore 2
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
307 WOODLAWN, KILGORE, TX 75662-3624
(903) 983-2110
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201442501
—
TX
05
—
201442502
—
TX
Enumeration date
04/18/2007
Last updated
09/25/2012
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