Provider Demographics
NPI:1083899009
Name:PHYSICIANS HOME VISITS, PC
Entity Type:Organization
Organization Name:PHYSICIANS HOME VISITS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-993-3146
Mailing Address - Street 1:3069 TRENWEST DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3211
Mailing Address - Country:US
Mailing Address - Phone:336-993-3146
Mailing Address - Fax:336-992-3930
Practice Address - Street 1:3069 TRENWEST DR
Practice Address - Street 2:STE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3211
Practice Address - Country:US
Practice Address - Phone:336-993-3146
Practice Address - Fax:336-992-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC023C9OtherBCBS
NC5950484Medicaid
NC34D1105236OtherCLIA
NC34D1105236OtherCLIA