Provider Demographics
NPI:1790035061
Name:TRINITY PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:TRINITY PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAKRISHNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRABHAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-321-3955
Mailing Address - Street 1:1259 FM 1463 RD STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5480
Mailing Address - Country:US
Mailing Address - Phone:832-321-3955
Mailing Address - Fax:832-321-3953
Practice Address - Street 1:1259 FM 1463 RD STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5480
Practice Address - Country:US
Practice Address - Phone:832-321-3955
Practice Address - Fax:832-321-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1075208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1075OtherMEDICAL LICENSE
TXN1075OtherMEDICAL LICENSE