Provider Demographics
NPI:1649513722
Name:TRISEASONS HEALTHCARE PLLC
Entity type:Organization
Organization Name:TRISEASONS HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLAYSTON
Authorized Official - Last Name:SKARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-528-1228
Mailing Address - Street 1:101 ALISON LN
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3457
Mailing Address - Country:US
Mailing Address - Phone:336-883-8633
Mailing Address - Fax:202-379-1739
Practice Address - Street 1:101 ALISON LN
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3457
Practice Address - Country:US
Practice Address - Phone:336-883-8633
Practice Address - Fax:202-379-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC188728261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976744Medicaid
1659314748OtherINDIVIDUAL NPI