Provider Demographics
NPI:1679192611
Name:TEMPLE TRIAGE PLLC
Entity Type:Organization
Organization Name:TEMPLE TRIAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAWANDA
Authorized Official - Middle Name:NACOLE
Authorized Official - Last Name:WHIDBY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-631-9200
Mailing Address - Street 1:8209 PENNSYLVANIA RUN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2143
Mailing Address - Country:US
Mailing Address - Phone:502-641-8857
Mailing Address - Fax:
Practice Address - Street 1:8209 PENNSYLVANIA RUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-2143
Practice Address - Country:US
Practice Address - Phone:502-631-9200
Practice Address - Fax:502-618-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care