# TRILLIUM MEDICAL GROUP OF VIRGINIA, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043421894
- **Authorized official:** MR. BOBBY L COATES (PRESIDENT)
- **Authorized official phone:** (727) 403-5221

## Contact information

- **Practice address:** 301 FUGATE ST \# B, DUFFIELD, VA 24244-9794
- **Practice address phone:** (800) 750-8103
- **Practice address fax:** (866) 788-0863
- **Mailing address:** PO BOX 23788, TAMPA, FL 33623-3788
- **Mailing address phone:** (800) 750-8103
- **Mailing address fax:** (866) 788-0863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/24/2007
- **Last updated:** 08/22/2020