| Trinity MD LLC | |
|
6205 Locke Ave Fort Worth TX 76116-4636 | |
| (817) 946-2051 | |
| Not Available |
| Full Name | Trinity MD LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 6205 Locke Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Henry Dollahite (OWNER/PROVIDER) |
| Authorized Official Contact | 9722490200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity MD LLC 6205 Locke Ave Fort Worth TX 76116-4636 Ph: (817) 946-2051 | Trinity MD LLC 6205 Locke Ave Fort Worth TX 76116-4636 Ph: (817) 946-2051 |
| NPI Number | 1811519093 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2026 |
| Certification Date | 05/11/2026 |
| Medicare PECOS PAC ID | 0345660080 |
|---|---|
| Medicare Enrollment ID | O20201019000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811519093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Joanna G Brochu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528235595 PECOS PAC ID: 9133297088 Enrollment ID: I20081006000562 |
| Provider Name | Brenda Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285930354 PECOS PAC ID: 5395929343 Enrollment ID: I20110415000212 |
| Provider Name | Mohammad I Malik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326200874 PECOS PAC ID: 9739241894 Enrollment ID: I20120111000888 |
| Provider Name | Eunice Orji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811248891 PECOS PAC ID: 6406001106 Enrollment ID: I20130312000038 |
| Provider Name | Isadora G Subia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821339201 PECOS PAC ID: 5597904128 Enrollment ID: I20130612000074 |
| Provider Name | Tabassum Naz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124368345 PECOS PAC ID: 4789826173 Enrollment ID: I20140410000153 |
| Provider Name | Alexandra M Villacres |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972659555 PECOS PAC ID: 4587710710 Enrollment ID: I20161022000170 |
| Provider Name | Jo a Myers |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1245627975 PECOS PAC ID: 6204119795 Enrollment ID: I20170207002405 |
| Provider Name | Henry Dollahite |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104243468 PECOS PAC ID: 7517186950 Enrollment ID: I20170726003495 |
| Provider Name | Margaret Bondoc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851826473 PECOS PAC ID: 6305110057 Enrollment ID: I20170920000647 |
| Provider Name | Amanda M Dayton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114449469 PECOS PAC ID: 7719252931 Enrollment ID: I20171013000662 |
| Provider Name | Lauri Clements |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992361307 PECOS PAC ID: 4789918061 Enrollment ID: I20190619002801 |
| Provider Name | Rehan Ahmed Malik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154843449 PECOS PAC ID: 1951633593 Enrollment ID: I20200709003765 |
| Provider Name | Katherine Lindsey Blalock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639771330 PECOS PAC ID: 0941612436 Enrollment ID: I20201207000745 |
| Provider Name | Gerardo Mederos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467949008 PECOS PAC ID: 0749688349 Enrollment ID: I20211012003552 |
| Provider Name | Stephene Suzette Gwinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285382606 PECOS PAC ID: 5294116174 Enrollment ID: I20220725000232 |
| Provider Name | Amber Deeann Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407712425 PECOS PAC ID: 6709364227 Enrollment ID: I20260127003642 |
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