Healthcare Provider Details

I. General information

NPI: 1922903269
Provider Name (Legal Business Name): TRI COUNTY COMMUNITY HEALTH COUNCIL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 RIVER RD
CLINTON NC
28328-6432
US

IV. Provider business mailing address

PO BOX 340
FOUR OAKS NC
27524-0340
US

V. Phone/Fax

Practice location:
  • Phone: 910-567-6194
  • Fax:
Mailing address:
  • Phone: 910-567-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM ELLISON
Title or Position: SNR DIRECTOR RCM
Credential:
Phone: 910-567-7065