Provider Demographics
NPI:1437568219
Name:TRINITY MEDICAL OF KENTUCKY
Entity Type:Organization
Organization Name:TRINITY MEDICAL OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:FORTICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-212-2211
Mailing Address - Street 1:8712 NOTTING HILL WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5912
Mailing Address - Country:US
Mailing Address - Phone:865-212-2211
Mailing Address - Fax:626-544-1629
Practice Address - Street 1:8712 NOTTING HILL WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5912
Practice Address - Country:US
Practice Address - Phone:865-212-2211
Practice Address - Fax:626-544-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45681207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty