Provider Demographics
NPI:1184665499
Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Entity Type:Organization
Organization Name:EAGLE PHYSICIANS AND ASSOCIATES PA
Other - Org Name:EAGLE FAMILY MEDICINE @ TRIAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, EAGLE BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-268-3201
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-852-3800
Mailing Address - Fax:336-852-5725
Practice Address - Street 1:3511 W MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4443
Practice Address - Country:US
Practice Address - Phone:336-852-3800
Practice Address - Fax:336-852-5725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE PHYSICIANS AND ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0134WOtherBCBS OF NC
NC890134WMedicaid
NC0134WOtherBCBS OF NC
NC890134WMedicaid