Provider Demographics
NPI:1417907395
Name:DOCTORS HOME VISITS OF THE TRIAD, PC
Entity Type:Organization
Organization Name:DOCTORS HOME VISITS OF THE TRIAD, PC
Other - Org Name:DOCTORS HOME VISITS OF WINSTON-SALEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-896-0826
Mailing Address - Street 1:11100 MEAD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2260
Mailing Address - Country:US
Mailing Address - Phone:225-295-3548
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:4035 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3325
Practice Address - Country:US
Practice Address - Phone:336-896-0826
Practice Address - Fax:336-896-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare ID - Type UnspecifiedAPPLIED FOR