Provider Demographics
NPI:1033072277
Name:TRINITY COLORECTAL SURGERY CLINIC PLLC
Entity type:Organization
Organization Name:TRINITY COLORECTAL SURGERY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-307-6054
Mailing Address - Street 1:1121 N JOE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1430
Mailing Address - Country:US
Mailing Address - Phone:817-307-6054
Mailing Address - Fax:
Practice Address - Street 1:1121 N JOE WILSON RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1430
Practice Address - Country:US
Practice Address - Phone:817-307-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty