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General NPI Number Information
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NPI Number | 1437568219
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Entity Type | Organization
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Legal Business Name | TRINITY MEDICAL OF KENTUCKY
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 8712 NOTTING HILL WAY
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City | KNOXVILLE
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State | TN
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Zip | 37923-5912
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Country | US
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Telephone | 865-212-2211
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Fax | 626-544-1629
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Provider Business Mailing Address
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Address Line | 8712 NOTTING HILL WAY
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City | KNOXVILLE
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State | TN
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Zip | 37923-5912
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Country | US
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Telephone | 865-212-2211
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Fax | 626-544-1629
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JAIRO ALFREDO FORTICH
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Credential | M.D.
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Telephone | 865-212-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 45681
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License Number State | KY
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