Organization
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Active
Other names
HealthServe North East
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN K ELLERBY MSPH (CHIEF EXECUTIVE OFFICER)
(336) 272-1050
Entity
Organization
Contact information
Practice address
1439 E CONE BLVD, GREENSBORO, NC 27405-4533
(336) 375-6104
(336) 375-9308
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024TE
BCBS
NC
01
—
2348638A
MEDICARE PART B
NC
01
—
34D0947992
CLIA
—
05
—
5916334
—
NC
Enumeration date
10/28/2010
Last updated
08/29/2011
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