NPIMap

Organization Active NPI

Triad Adult and Pediatric Medicine, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greensboro, NC
National Provider Identifier
1710049986
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Practice address
433 W. Meadowview Road
Greensboro, NC 27406-4316
Phone
(336) 370-9091
Fax
(336) 370-4922
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Authorized official

Name
Mr. Brian K Ellerby, MSPH,CMPE
Title
Chief Executive Officer
Phone
(336) 272-1050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

433 W. Meadowview Road
Greensboro, NC 27406-4316

Mailing address

1046 E Wendover Ave
Greensboro, NC 27405-6712
Phone (336) 272-1050

Other identifiers 1

IdentifierTypeStateIssuer
6005222MedicaidNC

Other names 1

  • Guilford Child Health, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Triad Adult and Pediatric Medicine Inc16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1710049986",
    "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": "433 W. MEADOWVIEW ROAD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274064316",
            "telephone_number": "336-370-9091",
            "fax_number": "336-370-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD ADULT AND PEDIATRIC MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2011-08-19",
        "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,CMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005222",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guilford Child Health, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.