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General NPI Number Information
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NPI Number | 1154791424
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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 | 09/30/2015
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Last Update Date | 09/30/2015
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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 | 336-355-9920
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Fax |
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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 | 336-355-9920
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Fax |
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Authorized Official
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Title or Position | INTERIM CEO
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Name | MICHELLE LEWIS
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Credential |
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Telephone | 336-355-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | P009673
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License Number State | NC
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