Provider Demographics
NPI:1538215751
Name:FAMILY MEDICAL CENTER, P.A. OF BILOXI
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER, P.A. OF BILOXI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:228-374-2800
Mailing Address - Street 1:1025 DIVISION ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2906
Mailing Address - Country:US
Mailing Address - Phone:228-374-2800
Mailing Address - Fax:228-374-2801
Practice Address - Street 1:1025 DIVISION ST
Practice Address - Street 2:SUITE B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2906
Practice Address - Country:US
Practice Address - Phone:228-374-2800
Practice Address - Fax:228-374-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15594207Q00000X
MS17719207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty