Triad Adult and Pediatric Medicine, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Doing business as

HealthServe North East

Practice address

1439 E Cone Blvd
Greensboro, NC 27405-4533

Phone

(336) 375-6104

Fax

(336) 375-9308

NPI assigned

Oct 28, 2010

Last updated

Aug 29, 2011By 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

Mr. Brian K Ellerby, MSPH

Title

Chief Executive Officer

Phone

(336) 272-1050

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• HealthServe North East Doing business as

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

{
    "created_epoch": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1326348087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056712",
            "telephone_number": "336-272-1050",
            "fax_number": "336-272-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 E CONE BLVD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054533",
            "telephone_number": "336-375-6104",
            "fax_number": "336-375-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD ADULT AND PEDIATRIC MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "ELLERBY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "336-272-1050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34D0947992",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916334",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "024TE",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "2348638A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthServe North East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Triad Adult and Pediatric Medicine Inc (Triad Adult and Pediatric Med- Greensboro Pharmacy)
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc. (TAPM Family Medicine at East Market Street)
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc. (Family Medicine at Northwood)
• Triad Adult and Pediatric Medicine, Inc. (Guilford Child Health-Wendover)
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc.
• Triad Adult and Pediatric Medicine, Inc. (Guilford Child Health-Spring Valley)

• Federally Qualified Health Center (FQHC) in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Federally Qualified Health Center (FQHC) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; 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.