Healthcare Provider Details

I. General information

NPI: 1982117271
Provider Name (Legal Business Name): TRIAD HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 HIGHWAY 22 E
OWENTON KY
40359-9176
US

IV. Provider business mailing address

PO BOX 845
WARSAW KY
41095-0845
US

V. Phone/Fax

Practice location:
  • Phone: 502-484-2117
  • Fax: 859-567-1253
Mailing address:
  • Phone: 502-484-2117
  • Fax: 859-567-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: JESSICA WHEELER
Title or Position: GENERAL MANAGER
Credential:
Phone: 859-567-1591