Provider Demographics
NPI:1780113191
Name:TRIAD WOMEN'S HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:TRIAD WOMEN'S HEALTH AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:336-841-6574
Mailing Address - Street 1:3750 ADMIRAL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1556
Mailing Address - Country:US
Mailing Address - Phone:336-841-8416
Mailing Address - Fax:336-841-6906
Practice Address - Street 1:3750 ADMIRAL DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1556
Practice Address - Country:US
Practice Address - Phone:336-841-8416
Practice Address - Fax:336-841-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20-0805834Medicaid