Provider Demographics
NPI:1205028818
Name:FLOYD TRILLIS, JR., MD, INC.
Entity Type:Organization
Organization Name:FLOYD TRILLIS, JR., MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:TRILLIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:440-835-6116
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE # 225
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-835-6116
Mailing Address - Fax:
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE # 225
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642997Medicaid
OH0642997Medicaid
0582393Medicare PIN