Provider Demographics
NPI:1194785071
Name:TRIAD WOMEN'S CENTER PA
Entity type:Organization
Organization Name:TRIAD WOMEN'S CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-841-6574
Mailing Address - Street 1:4510 PREMIER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8193
Mailing Address - Country:US
Mailing Address - Phone:336-841-6574
Mailing Address - Fax:336-841-6906
Practice Address - Street 1:4510 PREMIER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8193
Practice Address - Country:US
Practice Address - Phone:336-841-6574
Practice Address - Fax:336-841-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141XTOtherBC/BS PIN #
NC8937039Medicaid
NC5902270Medicaid
NC017UROtherBS GROUP
NC37039OtherBC/BS PIN #
NC5902270Medicaid
NC37039OtherBC/BS PIN #
NC141XTOtherBC/BS PIN #
C84172Medicare UPIN