Provider Demographics
NPI:1144860909
Name:ENTRUST HEALTH CARE LLC
Entity type:Organization
Organization Name:ENTRUST HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-969-3768
Mailing Address - Street 1:112 E LINE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5760
Mailing Address - Country:US
Mailing Address - Phone:903-969-3768
Mailing Address - Fax:
Practice Address - Street 1:112 E LINE ST STE 300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5760
Practice Address - Country:US
Practice Address - Phone:903-969-3768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care