NPIMap

Organization Active NPI

Trinity Clinic

  • Family Medicine Physician
  • Henderson, TN
National Provider Identifier
1285684258
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRINITY CLINIC
Practice address
500 N. Marshall
Henderson, TN 75652
Phone
(903) 657-1653
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Authorized official

Name
Mary Ann Harrison, CPC, CMC
Title
Physician Clinic Support Coordinato
Phone
(903) 510-1113

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Multi-Specialty Clinic/Center 261QM1300X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

500 N. Marshall
Henderson, TN 75652

Mailing address

PO Box 5500
Tyler, TX 75712
Phone (903) 324-6450

Other identifiers 1

IdentifierTypeStateIssuer
138737503MedicaidTX

Other names 1

  • Trinity Clinic Henderson Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tyler Radiologist25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1285684258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5500",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75712",
            "telephone_number": "903-324-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N. MARSHALL",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "75652",
            "telephone_number": "903-657-1653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHYSICIAN CLINIC SUPPORT COORDINATO",
        "authorized_official_telephone_number": "903-510-1113",
        "authorized_official_credential": "CPC, CMC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138737503",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Clinic Henderson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trinity Clinic Henderson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.