NPIMap

Organization Active NPI

Trinity Medical Clinic, LLC

  • Family Nurse Practitioner
  • Selmer, TN
National Provider Identifier
1013156629
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN0000007669 Issued in TN
Legal business name
TRINITY MEDICAL CLINIC, LLC
Practice address
832 Mulberry Ave
Selmer, TN 38375-2334
Phone
(731) 434-0200
Fax
(731) 434-0203
NPI assigned
Feb 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rhonda L Hunt, FNPNPI 1215050406
Title
Owner
Phone
(731) 434-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X APN0000007669 TN Primary

Addresses

Primary practice location

832 Mulberry Ave
Selmer, TN 38375-2334

Mailing address

832 Mulberry Ave
Selmer, TN 38375-2334
Phone (731) 424-0200

Other identifiers 1

IdentifierTypeStateIssuer
3341736OtherTNMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090326000481 TN Part B Supplier - Clinic/Group Practice 5395802912 Receives reassigned benefits from 3 practitioners
Practice locations: Selmer, TN
O20131108001888 TN Part A Provider - Rural Health Clinic 5395802912 Practice locations: Selmer, TN

Rural health clinic certification: CCN 448928

Legal name
TRINITY MEDICAL CLINIC, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 23, 2014
Last certification
Apr 12, 2022
Ownership / control type
1A
Organization structure
OtherProprietary
Incorporated
Jan 20, 2009 in TN
Enrollment address
832 Mulberry Ave
Selmer, TN 38375-2334

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1094923Trinity Medical Clinic, LLC832 Mulberry Ave, Selmer, TN 38375Provider-performed microscopyMar 20, 2027

National Provider Directory

National Provider Directory

Locations

832 Mulberry Ave
Selmer, TN 38375
Phone (731) 434-0200

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rhonda L Hunt Individual 5% Or Greater Direct Ownership Interest Jan 6, 2009
Operational/Managerial ControlOwner/Management/FNP-BC Feb 1, 2009 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1013156629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752334",
            "telephone_number": "731-424-0200",
            "fax_number": "731-434-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752334",
            "telephone_number": "731-434-0200",
            "fax_number": "731-434-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-434-0200",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000007669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "3341736",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Selmer, TN

Sources for this page

Verify at the official NPI Registry.