SOUTHERN TRINITY HEALTH SERVICES, INC. (NPI# 1255898953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255898953 |
| Entity Type | Organization |
| Organization Name | SOUTHERN TRINITY HEALTH SERVICES, INC. |
| Other Organization Name | TRINITY DENTAL CENTER |
| Practice Address |
100 Horseshoe Lane Weaverville CA 96093 |
| Mailing Address |
Po Box 960 Weaverville CA 96093-0960 |
| Practice Telephone | 5306238888 |
| Practice Fax Number | 5306238887 |
| Mailing Telephone | 5306238888 |
| Mailing Fax Number | 5306238887 |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2019-02-28 |
| Authorized Official Name | GRAYLAN LUPTON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7075746616 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 051026 | 05 | |
| CA | RHM70040F | 05 | |
| CA | MEDICARE PIN | ZZZ80700Z | 01 |
| CA | FHC70040F | 05 |
| Other Name | Type Code |
|---|---|
| Trinity Dental Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174693493 | Southern Trinity Health Services, Inc. | Family Medicine | 321 Van Duzen Road, Mad River, CA 95552-0004 | 2006-11-08 |
| 1619236023 | Southern Trinity Health Services, Inc. | Clinic/Center | 500 B Street, Scotia, CA 95565 | 2012-05-07 |
| Street Address |
100 HORSESHOE LANE |
| City | WEAVERVILLE |
| State | CA |
| Zip Code | 96093 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639307465 | Frederick Reese Carlin Jr Dds Inc | Dentist | 100 Horseshoe Lane, Weaverville, CA 96093 | 2009-07-01 |
| 1356579197 | Frederick Reese Carlin Jr. | Dentist | 100 Horseshoe Lane, Weaverville, CA 96093 | 2009-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861981011 | Timothy Dobbs | Case Manager/Care Coordinator | 333 Tom Bell Rd, Weaverville, CA 96093 | 2018-05-03 |
| 1386164580 | Redding Rancheria | Clinic/Center | 31660 Hwy 3, Weaverville, CA 96093 | 2017-06-20 |
| 1578093134 | Gregory James Lindley | Case Manager/Care Coordinator | 333 Tombell Road, Weaverville, CA 96093 | 2017-06-15 |
| 1134595614 | Tammerab Baudizzon | Case Manager/Care Coordinator | 51 Industrial Way, 333 Tom Bell Rd, Weaverville, CA 96093 | 2015-08-19 |
| 1023493913 | Robert Alan Millette | Registered Nurse | 81 Taylor St., Weaverville, CA 96093 | 2015-07-21 |
| 1316327331 | Ann Nguyen | Dentist | 100 Horsehoe Ln, Weaverville, CA 96093 | 2015-06-04 |
| 1962801225 | Daniel W Powers | Dentist | 91 Brooks Lane, Weaverville, CA 96093 | 2014-08-22 |
| 1275978496 | Tanya E Menezes | Counselor | 31660 Ca-3, Weaverville, CA 96093 | 2013-05-01 |
| 1568714939 | Angela Marie Benson | Counselor | 1640 Main St., Weaverville, CA 96093 | 2012-10-10 |
| 1922353242 | Megan Michelle Blanchard | Registered Nurse | #51 Industrial Park, Trinity County Health & Human Services, Weaverville, CA 96093 | 2012-07-24 |
| Find all providers in zip 96093 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386164580 | Redding Rancheria | Clinic/Center | 31660 Hwy 3, Weaverville, CA 96093 | 2017-06-20 |
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| Find all providers with the same taxonomy | ||||
| City | WEAVERVILLE |
| Zip Code | 96093 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.