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General NPI Number Information
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NPI Number | 1598762940
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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 | 06/30/2005
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 1046 E WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-6712
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Country | US
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Telephone | 336-272-1050
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Fax | 336-272-0155
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Provider Business Mailing Address
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Address Line | 1046 E WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-6712
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Country | US
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Telephone | 336-272-1050
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Fax | 336-272-0155
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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 CMPE
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Telephone | 336-272-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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