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NPI Code Detail

MEDICARE: TRIUMPH LLC

MEDICARE: TRIUMPH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianNC

General Provider Information

NPI Number : 1225347842
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIUMPH LLC
Provider Business Mailing Address
First Line : 3210 FAIRHILL DR
Second Line :
City : RALEIGH
State : NC
Zip : 27612-3215
Country : US
Telephone Number : 919-256-0824
Fax Number : 919-256-0833
Provider Business Practice Location Address
First Line : 309 WYCHE ST
Second Line :
City : HENDERSON
State : NC
Zip : 27536-4246
Country : US
Telephone Number : 252-438-2581
Fax Number : 252-438-6364
Authorized Official
Title or Position : MEMBER MGR./OWNER
Name : HAROLD E JONES JR.
Credential :
Telephone Number : 919-256-0824
Provider Enumeration Date : 09/30/2010
Last Update Date : 09/30/2010

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Directions to “TRIUMPH LLC ” Practice Location

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