Provider Demographics
NPI:1821001132
Name:TRINITY FAMILY HEALTHCARE, PSC
Entity Type:Organization
Organization Name:TRINITY FAMILY HEALTHCARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAMPAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:606-248-5151
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965
Mailing Address - Country:US
Mailing Address - Phone:606-248-5151
Mailing Address - Fax:606-248-5107
Practice Address - Street 1:3602 W CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-5151
Practice Address - Fax:606-248-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4312P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00088Medicare PIN