Triad Medical Group PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

39460 Issued in NC

Legal business name

TRIAD MEDICAL GROUP PA

Practice address

2031 Martin Luther King Jr Dr
Greensboro, NC 27406-3342

Phone

(704) 838-0516

Fax

(704) 838-0565

NPI assigned

Nov 4, 2016

Last updated

Aug 6, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nekita Clyburn

Title

Billing Administration

Phone

(336) 790-9787

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565049600000",
    "number": "1194267336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 MARTIN LUTHER KING JR DR STE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274063300",
            "telephone_number": "336-790-9787",
            "fax_number": "336-790-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2031 MARTIN LUTHER KING JR DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274063342",
            "telephone_number": "704-838-0516",
            "fax_number": "704-838-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2019-08-06",
        "status": "A",
        "authorized_official_last_name": "CLYBURN",
        "authorized_official_first_name": "NEKITA",
        "authorized_official_title_or_position": "BILLING ADMINISTRATION",
        "authorized_official_telephone_number": "336-790-9787"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "39460",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "39460",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Triad Human Services, LLC
• Triad Imaging LLC (Novant Health Imaging Triad)
• Triad Integrative Wellness Center Inc
• Triad Internal Medicine Associates 2LLC
• Triad Internal Medicine Associates PA
• Triad Mobility,Inc (Triad Behavioral Health Services)
• Triad Ophthalmology Consultants, PLLC
• Triad Pelvic Health Physical Therapy, LLC
• Triad Physical Medicine
• Triad Play

• Family Medicine Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.