NPIMap

Organization Active NPI

Northern Triad Surgical Associates, PLLC

  • Surgery Physician
  • Reidsville, NC
National Provider Identifier
1639312879
Registry record updated Jul 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
200002376723 Issued in NC
Legal business name
NORTHERN TRIAD SURGICAL ASSOCIATES, PLLC
Practice address
1818 Richardson Dr
Ste. E
Reidsville, NC 27320-5451
Phone
(336) 634-0095
Fax
(336) 616-0320
NPI assigned
Apr 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2013

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

Authorized official

Name
Mark A Jenkins, M.D.NPI 1629092184
Title
Member
Phone
(336) 634-0095

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 200002376723 NC Primary

Addresses

Primary practice location

1818 Richardson Dr
Ste. E
Reidsville, NC 27320-5451

Mailing address

1818 Richardson Dr.
Ste. E
Reidsville, NC 27320
Phone (336) 634-0095

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1639312879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 RICHARDSON DR.",
            "address_2": "STE. E",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "27320",
            "telephone_number": "336-634-0095",
            "fax_number": "336-616-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 RICHARDSON DR",
            "address_2": "STE. E",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273205451",
            "telephone_number": "336-634-0095",
            "fax_number": "336-616-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN TRIAD SURGICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "336-634-0095",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NC",
            "license": "200002376723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; 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.