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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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679619852
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIUMPH LLC
Provider Business Mailing Address
First Line : 351 RIVERSIDE DR
Second Line : SUITE 100
City : MOUNT AIRY
State : NC
Zip : 27030-3850
Country : US
Telephone Number : 336-783-6919
Fax Number :
Provider Business Practice Location Address
First Line : 351 RIVERSIDE DR
Second Line : SUITE 100
City : MOUNT AIRY
State : NC
Zip : 27030-3850
Country : US
Telephone Number : 336-783-6919
Fax Number :
Authorized Official
Title or Position : CEO
Name : PAUL CALDWELL
Credential :
Telephone Number : 919-467-2433
Provider Enumeration Date : 01/29/2007
Last Update Date : 08/22/2020

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Directions to “TRIUMPH LLC ” Practice Location

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