Provider Demographics
NPI:1447875703
Name:TRIUM PROFESSIONAL CORPORATION - KY
Entity type:Organization
Organization Name:TRIUM PROFESSIONAL CORPORATION - KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-375-1094
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37056-1017
Mailing Address - Country:US
Mailing Address - Phone:877-626-5321
Mailing Address - Fax:615-246-3827
Practice Address - Street 1:460 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2525
Practice Address - Country:US
Practice Address - Phone:615-375-1094
Practice Address - Fax:615-246-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty