Trinity Pediatric Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TRINITY PEDIATRIC CLINIC

Practice address

1860 Chadwick Dr
Suite 205
Jackson, MS 39204-3463

Phone

(601) 376-2857

NPI assigned

Apr 29, 2011

Organization subpart

No

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

Authorized official

Name

Audrey U Robertson, MD

Title

Manager

Phone

(601) 376-2857

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1304035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1316238926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 CHADWICK DR",
            "address_2": "SUITE 205",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043463",
            "telephone_number": "601-376-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 CHADWICK DR",
            "address_2": "SUITE 205",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043463",
            "telephone_number": "601-376-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-29",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-376-2857",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118818",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose Ricardo Trigueros Jovel, MD
• William Bradley Trimble II
• Trinity Behavioral Health, LLC
• Trinity Emergency Medical Transportation Corporation (Trinity Medical Transportation)
• Trinity Mercy Home Health Care Agency LLC
• Trinity Rehabilitation Inc
• Shakaylia Triplett
• Jennifer Tripoli
• Triumphant Children & Tutorial Services
• William Troutman, MD

• Primary Care Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.