Provider Demographics
NPI:1336640325
Name:TRINITY FAMILY MEDICAL PRACTICE INC
Entity Type:Organization
Organization Name:TRINITY FAMILY MEDICAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-624-6312
Mailing Address - Street 1:174 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8087
Mailing Address - Country:US
Mailing Address - Phone:917-747-4516
Mailing Address - Fax:561-627-3991
Practice Address - Street 1:601 UNIVERSITY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2788
Practice Address - Country:US
Practice Address - Phone:561-323-4546
Practice Address - Fax:561-627-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty