Trinity Health South PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME104865 Issued in FL

Legal business name

TRINITY HEALTH SOUTH PLLC

Practice address

475 W Town PL
Suite 105
St Augustine, FL 32092-3648

Phone

(904) 806-4579

Fax

(904) 863-5566

NPI assigned

Nov 9, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wendy C Lu

Title

Credentialing Coordinator

Phone

(904) 221-2535

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1780126664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CALLE NORTE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32092",
            "telephone_number": "904-806-4579",
            "fax_number": "904-863-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 W TOWN PL",
            "address_2": "SUITE 105",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923648",
            "telephone_number": "904-806-4579",
            "fax_number": "904-863-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH SOUTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "LU",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "904-221-2535"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME104865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.