Active NPI
Triumph LLC
- Psychiatry Physician
- Statesville, NC
National Provider Identifier
1972659993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- TRIUMPH LLC
- Practice address
- 318 Turnersburg Hwy
Statesville, NC 28625-2798 - Phone
- (704) 873-1114
- NPI assigned
- Jan 25, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Brenda Frazier
- Title
- Provider Enrollment Specialist
- Phone
- (919) 256-0824
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | Primary |
Addresses
Primary practice location
318 Turnersburg Hwy
Statesville, NC 28625-2798
Mailing address
3210 Fairhill Dr
Raleigh, NC 27612-3220
Phone (919) 256-0824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5902798 | Medicaid | NC |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1185235200000",
"number": "1972659993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 FAIRHILL DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276123220",
"telephone_number": "919-256-0824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 TURNERSBURG HWY",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286252798",
"telephone_number": "704-873-1114"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIUMPH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-24",
"status": "A",
"authorized_official_last_name": "FRAZIER",
"authorized_official_first_name": "BRENDA",
"authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
"authorized_official_telephone_number": "919-256-0824",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5902798",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.