Provider Demographics
NPI:1083041982
Name:TRIAD HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:TRIAD HEALTH SYSTEMS, INC.
Other - Org Name:GALLATIN COUNTY MIDDLE SCHOOL BASED CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-567-1271
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0426
Mailing Address - Country:US
Mailing Address - Phone:859-567-1271
Mailing Address - Fax:859-567-1258
Practice Address - Street 1:88 PAWPRINT PATH
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-9376
Practice Address - Country:US
Practice Address - Phone:859-567-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD HEALTH SYSTEMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700173261Q00000X, 261QF0400X, 261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty