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General NPI Number Information
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NPI Number | 1063712727
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Entity Type | Organization
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Legal Business Name | TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 1002 S EUGENE ST
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City | GREENSBORO
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State | NC
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Zip | 27406-1308
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Country | US
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Telephone | 336-355-9701
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Fax | 336-676-6140
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Provider Business Mailing Address
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Address Line | 1002 S EUGENE ST
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City | GREENSBORO
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State | NC
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Zip | 27406-1308
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Country | US
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Telephone | 336-355-9701
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Fax | 336-676-6140
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. BRIAN K ELLERBY
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Credential | MSPH
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Telephone | 336-355-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 10670
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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