Provider Demographics
NPI:1194994335
Name:TRINITY HOLISTIC FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:TRINITY HOLISTIC FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BIRDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-737-3331
Mailing Address - Street 1:PO BOX 126409
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-0409
Mailing Address - Country:US
Mailing Address - Phone:817-737-3331
Mailing Address - Fax:817-737-2333
Practice Address - Street 1:9239 VISTA WAY
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2451
Practice Address - Country:US
Practice Address - Phone:817-737-3331
Practice Address - Fax:817-737-2333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN S BIRDY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00676QMedicare UPIN