Healthcare Provider Details

I. General information

NPI: 1144575929
Provider Name (Legal Business Name): CARDINAL HEALTH SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 TRENWEST DR STE 200
WINSTON SALEM NC
27103-3211
US

IV. Provider business mailing address

PO BOX 30575
WINSTON SALEM NC
27130-0575
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-0962
  • Fax: 336-992-3930
Mailing address:
  • Phone: 336-448-0962
  • Fax: 336-992-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number32185
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number32185
License Number StateNC

VIII. Authorized Official

Name: MR. HENRY FRANKLIN TRIPP JR.
Title or Position: DIRECTOR
Credential: M.D.
Phone: 336-993-3146