Provider Demographics
NPI:1518169242
Name:TRENTON CLINIC, LLC
Entity Type:Organization
Organization Name:TRENTON CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RUE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-466-9300
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42286-0317
Mailing Address - Country:US
Mailing Address - Phone:270-466-9300
Mailing Address - Fax:270-466-3300
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:KY
Practice Address - Zip Code:42286-0317
Practice Address - Country:US
Practice Address - Phone:270-466-9300
Practice Address - Fax:270-466-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7849Medicare PIN