Provider Demographics
NPI:1104248962
Name:TRIAD HEALTH SYSTEMS INC.
Entity type:Organization
Organization Name:TRIAD HEALTH SYSTEMS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-567-1271
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-0845
Mailing Address - Country:US
Mailing Address - Phone:859-567-1591
Mailing Address - Fax:859-567-1253
Practice Address - Street 1:329 FLOYD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8261
Practice Address - Country:US
Practice Address - Phone:502-732-1082
Practice Address - Fax:859-567-1253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD HEALTH SYSTEMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-14
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
KY261QP2300X, 363LF0000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty