Healthcare Provider Details

I. General information

NPI: 1750674735
Provider Name (Legal Business Name): HSTRIAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 W MARKET ST SUITE A
GREENSBORO NC
27407-1542
US

IV. Provider business mailing address

4518 W MARKET ST SUITE A
GREENSBORO NC
27407-1542
US

V. Phone/Fax

Practice location:
  • Phone: 336-235-4022
  • Fax: 336-235-4023
Mailing address:
  • Phone: 336-235-4022
  • Fax: 336-235-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROOSEVELT SMITH
Title or Position: OWNER
Credential: MD
Phone: 336-235-4022