| Trinity Health South Pllc | |
|
475 W Town Pl Suite 105 St Augustine FL 32092-3648 | |
| (904) 806-4579 | |
| (904) 863-5566 |
| Full Name | Trinity Health South Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 475 W Town Pl, St Augustine, Florida |
| Authorized Official Name and Position | Wendy C Lu (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9042212535 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Health South Pllc 110 Calle Norte St Augustine FL 32092 Ph: (904) 806-4579 | Trinity Health South Pllc 475 W Town Pl Suite 105 St Augustine FL 32092-3648 Ph: (904) 806-4579 |
| NPI Number | 1780126664 |
|---|---|
| Provider Enumeration Date | 11/09/2016 |
| Last Update Date | 11/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780126664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME104865 (Florida) | Primary |
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