Provider Demographics
| NPI: | 1285684225 |
|---|---|
| Name: | CHRISTUS TRINITY CLINIC |
| Entity type: | Organization |
| Organization Name: | CHRISTUS TRINITY CLINIC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROBERT |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KARL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 469-282-2611 |
| Mailing Address - Street 1: | PO BOX 846098 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DALLAS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75284-6098 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 903-324-6450 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 520 DOUGLAS BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | TYLER |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75702-8307 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 903-315-4119 |
| Practice Address - Fax: | 903-525-1566 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-11 |
| Last Update Date: | 2024-04-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 1091520016 | Other | PALMETTO DME-KILGORE |
| TX | 138737529 | Medicaid | |
| TX | 138737510 | Medicaid | |
| TX | 138737521 | Medicaid | |
| TX | 138737527 | Medicaid | |
| TX | 138737530 | Medicaid | |
| TX | 138737535 | Medicaid | |
| TX | 138737531 | Medicaid | |
| TX | 138737522 | Medicaid | |
| TX | 138737511 | Medicaid | |
| TX | 138737528 | Medicaid | |
| TX | 138737532 | Medicaid | |
| TX | 138737533 | Medicaid | |
| TX | 138737536 | Medicaid | |
| TX | 168206402 | Medicaid | |
| TX | 138737504 | Medicaid | |
| TX | 138737506 | Medicaid | |
| TX | 141835201 | Medicaid | |
| TX | 141838601 | Other | THSTEPS-WHITEHOUSE |
| TX | 063685402 | Medicaid | |
| TX | 138737524 | Medicaid | |
| TX | 138737534 | Medicaid | |
| TX | 177294903 | Medicaid | |
| TX | 138737529 | Medicaid | |
| TX | 00T68U | Medicare Oscar/Certification | |
| TX | CR1018 | Medicare PIN | |
| TX | CN5356 | Medicare PIN | |
| TX | CH5243 | Medicare PIN | |
| TX | 00T72U | Medicare ID - Type Unspecified | LAKE P, LINDALE, FP'S GRO |
| TX | 138737528 | Medicaid | |
| TX | 138737527 | Medicaid | |
| TX | 141835201 | Medicaid | |
| TX | 138737511 | Medicaid | |
| TX | 0071AU | Medicare Oscar/Certification | |
| TX | DC5235 | Medicare PIN | |
| TX | 00T69U | Medicare ID - Type Unspecified | SPECIALITY GROUP NUMBER |
| TX | 00T68U | Medicare ID - Type Unspecified | ANESTHESIA GROUP NUMBER |
| TX | 138737531 | Medicaid | |
| TX | 138737521 | Medicaid | |
| TX | 138737524 | Medicaid | |
| TX | 063685402 | Medicaid | |
| TX | 177294903 | Medicaid | |
| TX | CL8313 | Medicare Oscar/Certification | |
| TX | CN3629 | Medicare PIN | |
| TX | 00T66U | Medicare ID - Type Unspecified | PEDI,CHILDRENS, ATHENS-PE |
| TX | 138737510 | Medicaid | |
| TX | 168206402 | Medicaid | |
| TX | 0069AU | Medicare Oscar/Certification | |
| TX | 00T66U | Medicare Oscar/Certification | |
| TX | CR1017 | Medicare PIN |
