Organization
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Active
Other names
Guilford Child Health-High Point
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
400 E COMMERCE AVE, HIGH POINT, NC 27260-5221
(336) 884-0224
(336) 884-3471
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
—
0272J
BCBS
NC
01
—
2318638A
MEDICARE PART B
NC
01
—
34D0926775
CLIA
—
05
—
890245J
—
NC
Enumeration date
07/14/2005
Last updated
08/29/2011
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