Family Medicine At Eugene Street
LBN: Triad Adult And Pediatric Medicine, Inc.
Family Medicine At Eugene Street is an health care organization with primary practice located at 1002 S Eugene St , Greensboro NC 27406-1308. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), Suppliers / Clinic Pharmacy. Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty.
Triad Adult And Pediatric Medicine, Inc. can be contacted via phone (336) 355-9701, or through Ellerby, Brian K via phone (336) 355-9696.
Contact Information
Primary practice address
1002 S Eugene St
Greensboro NC 27406-1308
Phone: (336) 355-9701
Fax: (336) 676-6140
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) | 261QF0400X | ||
| Suppliers / Clinic Pharmacy | 3336C0002X | 10670 | North Carolina |
Profile Details
| NPI number | 1063712727 |
|---|---|
| LBN Legal business name | Triad Adult And Pediatric Medicine, Inc. |
| DBA Doing business as | Family Medicine At Eugene Street |
| Authorized official | Ellerby, Brian K MSPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 28th, 2010 |
| Last updated | Nov 26th, 2013 - about 12 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063712727 | NPPES |
| Other | 34D0700291 | CLIA | |
| Other | 2348638A | CLIA | |
| MEDICAID | 344045A | CLIA | |
| Other | 3460247 | CLIA | |
| Other | 56162 | CLIA | |
| Other | 34-1962 | CLIA | |
| MEDICAID | 344045B | CLIA | |
| MEDICAID | 344045C | CLIA | |
| Other | 024UF | CLIA |
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Triad Adult And Pediatric Medicine, Inc.
1002 S Eugene St , Greensboro NC 27406-1308