Provider Demographics
NPI:1770016941
Name:TRIPCO MEDICAL LLC
Entity Type:Organization
Organization Name:TRIPCO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-632-4515
Mailing Address - Street 1:111 DERRICK PL
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1325
Mailing Address - Country:US
Mailing Address - Phone:270-874-2629
Mailing Address - Fax:270-874-2774
Practice Address - Street 1:111 DERRICK PL
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1325
Practice Address - Country:US
Practice Address - Phone:270-874-2629
Practice Address - Fax:270-874-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty