Provider Demographics
NPI:1982615282
Name:TRIAD MEDICINE AND PEDIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:TRIAD MEDICINE AND PEDIATRIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-634-3902
Mailing Address - Street 1:217 TURNER DR STE F
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5754
Mailing Address - Country:US
Mailing Address - Phone:336-634-3902
Mailing Address - Fax:336-634-3933
Practice Address - Street 1:217 TURNER DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5754
Practice Address - Country:US
Practice Address - Phone:336-634-3902
Practice Address - Fax:336-634-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2402033AMedicare PIN