Piedmont Triad Regional Development Corporation

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Legal business name

PIEDMONT TRIAD REGIONAL DEVELOPMENT CORPORATION

Practice address

1398 Carrollton Crossing Dr
Kernersville, NC 27284-3896

Phone

(336) 904-0300

Fax

(336) 904-0336

NPI assigned

Jan 13, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Matthew Dolge

Title

Executive Director

Phone

(336) 904-0300

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1093304156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1398 CARROLLTON CROSSING DR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272843896",
            "telephone_number": "336-904-0300",
            "fax_number": "336-904-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1398 CARROLLTON CROSSING DR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272843896",
            "telephone_number": "336-904-0300",
            "fax_number": "336-904-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT TRIAD REGIONAL DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "DOLGE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-904-0300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.ptrc.org/ptrdc",
            "affiliation": "N",
            "address_1": "1398 Carrollton Crossing Dr",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272843896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community Health Worker in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Community Health Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.