Provider Demographics
NPI:1275015794
Name:TRIAD CARE, INC
Entity Type:Organization
Organization Name:TRIAD CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-541-6475
Mailing Address - Street 1:306 POMONA DR STE F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1643
Mailing Address - Country:US
Mailing Address - Phone:336-541-6475
Mailing Address - Fax:336-541-6485
Practice Address - Street 1:306 POMONA DR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1643
Practice Address - Country:US
Practice Address - Phone:336-541-6475
Practice Address - Fax:336-541-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 251B00000X
NC5004403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty