Organization Name: | TRILLIUM MEDICAL GROUP OF VIRGINIA |
NPI Number: | 1164623211 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BOBBY L COATES (PRESIDENT) |
Mailing Address: | Hwy 58 Dryden |
State: | VA US |
Postal Code: | 24243 |
Phone Number: | 8007508103 |
Fax Number: | 8667880863 |
NPI Enumeration Date: | 05/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |