Organization
TRILLIUM MEDICAL GROUP OF FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY L COATES (PRESIDENT)
(727) 403-5221
Entity
Organization
Contact information
Practice address
21827 STATE ROAD 54, LUTZ, FL 33549-6924
(727) 750-8103
(866) 788-0863
Mailing address
PO BOX 23788, TAMPA, FL 33623-3788
(800) 750-8103
(866) 788-0863
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34129
BCBS GROUP
FL
Enumeration date
05/24/2007
Last updated
08/22/2020
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