| Organization Name: | TRINITY CLINIC |
| NPI Number: | 1316198310 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ANN HARRISON (PROVIDER ENROLLMENT COORDINATOR) |
| Mailing Address: | 3203 S Main St Lindale |
| State: | TX US |
| Postal Code: | 757717727 |
| Phone Number: | 9038820991 |
| Fax Number: | 9038827751 |
| NPI Enumeration Date: | 10/08/2008 |
| NPI Last Update Date: | 09/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |