Organization
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Active
Other names
Guilford Child Health-Wendover
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN K ELLERBY MSPH CMPE (CHIEF EXECUTIVE OFFICER)
(336) 272-1050
Entity
Organization
Contact information
Practice address
1046 E WENDOVER AVE, GREENSBORO, NC 27405-6712
(336) 272-1050
(336) 272-0155
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
—
0244U
BCBS OF NC
NC
01
—
2348638A
MEDICARE
NC
01
—
34D0926152
CLIA
NC
05
—
890244U
—
NC
Enumeration date
06/30/2005
Last updated
08/29/2011
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