Provider Demographics
NPI:1144575929
Name:CARDINAL HEALTH SERVICES, PC
Entity Type:Organization
Organization Name:CARDINAL HEALTH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-993-3146
Mailing Address - Street 1:PO BOX 30575
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27130-0575
Mailing Address - Country:US
Mailing Address - Phone:336-448-0962
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:336-448-0962
Practice Address - Fax:336-992-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32185207QG0300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D2049903OtherCLIA #