Organization
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Active
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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