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Organization

TRIAD ADULT AND PEDIATRIC MEDICINE, INC

Active
Other names
Clara F. Gunn Medical Center
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MICHELLE A. LEWIS (INTERIM CHIEF EXECUTIVE OFFICER)
(336) 355-9715
Entity
Organization

Contact information

Practice address
922 THIRD AVE, REIDSVILLE, NC 27320-4440
(336) 355-9913
(336) 637-8091
Mailing address
1002 S EUGENE ST, GREENSBORO, NC 27406-1308
(336) 355-9715
(336) 763-2896

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1962741421
NC
Enumeration date
02/04/2013
Last updated
04/20/2015
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