Provider Demographics
NPI:1851386510
Name:TRINITY FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:TRINITY FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-285-7592
Mailing Address - Street 1:112 MEDICAL VILLAGE DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1668
Mailing Address - Country:US
Mailing Address - Phone:910-285-7592
Mailing Address - Fax:910-285-4610
Practice Address - Street 1:112 MEDICAL VILLAGE DR
Practice Address - Street 2:UNIT D
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1668
Practice Address - Country:US
Practice Address - Phone:910-285-7592
Practice Address - Fax:910-285-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902457Medicaid
NC2342506Medicare ID - Type Unspecified