1780113191 NPI number — TRIAD WOMEN'S HEALTH AND WELLNESS CENTER

Table of content: (NPI 1780113191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780113191 NPI number — TRIAD WOMEN'S HEALTH AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIAD WOMEN'S HEALTH AND WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780113191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 ADMIRAL DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27265-1556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-841-8416
Provider Business Mailing Address Fax Number:
336-841-6906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 ADMIRAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-1556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-841-8416
Provider Business Practice Location Address Fax Number:
336-841-6906
Provider Enumeration Date:
06/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
ELEANOR
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
336-841-6574

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20-0805834 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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