Provider Demographics
NPI:1619507431
Name:TRICOUNTY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:TRICOUNTY PHYSICIANS, LLC
Other - Org Name:VILLA HEALTH SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIVIC
Authorized Official - Middle Name:DELOS REYES
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-561-6299
Mailing Address - Street 1:1507 BUENOS AIRES BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8974
Mailing Address - Country:US
Mailing Address - Phone:352-561-6299
Mailing Address - Fax:
Practice Address - Street 1:1507 BUENOS AIRES BLVD STE 102
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8974
Practice Address - Country:US
Practice Address - Phone:352-561-6299
Practice Address - Fax:352-750-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty