Provider Demographics
NPI:1679704878
Name:TRI-COUNTY INFECTIOUS DISEASE
Entity Type:Organization
Organization Name:TRI-COUNTY INFECTIOUS DISEASE
Other - Org Name:TRI-COUNTY INFECTIOUS DISEASE CONSULTANTS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-633-0215
Mailing Address - Street 1:1576 BELLA CRUZ DRIVE
Mailing Address - Street 2:SUITE 336
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8969
Mailing Address - Country:US
Mailing Address - Phone:352-633-0215
Mailing Address - Fax:352-633-0219
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:SUITE 130
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5609
Practice Address - Country:US
Practice Address - Phone:352-633-0215
Practice Address - Fax:352-633-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001364700Medicaid
CH467AMedicare UPIN