MEDICARE: TRIAD WOMEN'S CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141XT	OTHER	NC	BC/BS PIN #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	017UR	OTHER	NC	BS GROUP
5	37039	OTHER	NC	BC/BS PIN #

General Provider Information

NPI Number	:	1194785071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD WOMEN'S CENTER PA

Provider Business Mailing Address
First Line	:	4510 PREMIER DR
Second Line	:	SUITE 102
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8193
Country	:	US
Telephone Number	:	336-841-6574
Fax Number	:	336-841-6906

Provider Business Practice Location Address
First Line	:	4510 PREMIER DR
Second Line	:	SUITE 102
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8193
Country	:	US
Telephone Number	:	336-841-6574
Fax Number	:	336-841-6906

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELEANOR ELAINE GREENE
Credential	:	MD
Telephone Number	:	336-841-6574

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/19/2009

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Directions to “TRIAD WOMEN'S CENTER PA ” Practice Location

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