Organization
TRIAD ADULT AND PEDIATRIC MEDICINE INC
Active
Other names
High Point Adult Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN ELLERBY MSPH (CHIEF EXECUTIVE OFFICER)
(336) 272-1050
Entity
Organization
Contact information
Practice address
624 QUAKER LN STE 100C, HIGH POINT, NC 27262-3832
(336) 878-6027
(336) 878-6189
Mailing address
1046 E WENDOVER AVE, GREENSBORO, NC 27405-6712
(336) 272-1050
(336) 272-0155
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024UE
BCBS OF NC
NC
01
—
34-1964
MEDICARE A
NC
05
—
344044A
—
NC
05
—
344044B
—
NC
05
—
344044C
—
NC
01
—
3460235
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
34D1002754
CLIA
NC
01
—
56162
MEDCOST
NC
Enumeration date
10/26/2010
Last updated
08/09/2012
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