MEDICARE: TRINITY FAMILY MEDICAL CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	059170	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598782401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY FAMILY MEDICAL CENTER, PA

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32727-0490
Country	:	US
Telephone Number	:	352-253-2511
Fax Number	:	352-253-2522

Provider Business Practice Location Address
First Line	:	1850 PREVATT ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6123
Country	:	US
Telephone Number	:	352-253-2511
Fax Number	:	352-253-2522

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN E YOUNG
Credential	:	DO
Telephone Number	:	352-253-2511

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	12/03/2025

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