Provider Demographics
NPI:1780109694
Name:TRIAD HEALTH SYSTEMS INC.
Entity type:Organization
Organization Name:TRIAD HEALTH SYSTEMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-567-1271
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-0845
Mailing Address - Country:US
Mailing Address - Phone:859-567-1271
Mailing Address - Fax:859-567-1253
Practice Address - Street 1:1005 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9041
Practice Address - Country:US
Practice Address - Phone:502-484-2595
Practice Address - Fax:859-567-1253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD HEALTH SYSTEMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-11
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental