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

Guilford Child Health-Spring Valley

Practice address

433 W Meadowview Road
Greensboro, NC 27406-4316

Phone

(336) 370-9091

Fax

(336) 370-4922

NPI assigned

Jul 12, 2005

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 CMPE

Title

Chief Executive Officer

Phone

(336) 272-1050

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Guilford Child Health-Spring Valley Doing business as

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1831197938",
    "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": "2005-07-12",
        "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 CMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "0272J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "34D0017613",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "2348638A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890272J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guilford Child Health-Spring Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Triad Adult and Pediatric Medicine, Inc. (HealthServe North East)
• 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. (Family Medicine at Arlington Street)
• Triad Behavioral Resources
• Triad Breast Imaging Center, LLC (Novant Health Breast Imaging Center Greensboro)
• Triad Centers for Youth, Inc.
• Triad Child & Family Counseling, PLLC

• 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.