Provider Demographics
NPI:1356892277
Name:CHRISTUS TRINITY CLINIC - CARDIOLOGY
Entity type:Organization
Organization Name:CHRISTUS TRINITY CLINIC - CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF CARDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:FAGG
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-606-7000
Mailing Address - Street 1:703 S FLEISHEL AVE
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2015
Mailing Address - Country:US
Mailing Address - Phone:903-606-7000
Mailing Address - Fax:
Practice Address - Street 1:703 S FLEISHEL AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2015
Practice Address - Country:US
Practice Address - Phone:903-606-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132260261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center