Healthcare Provider Details

I. General information

NPI: 1407025125
Provider Name (Legal Business Name): TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 EASY ST
DUNN NC
28334-7988
US

IV. Provider business mailing address

PO BOX 227
NEWTON GROVE NC
28366-0227
US

V. Phone/Fax

Practice location:
  • Phone: 910-567-6194
  • Fax: 910-567-4389
Mailing address:
  • Phone: 910-567-6194
  • Fax: 910-567-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PAMELA M TRIPP
Title or Position: CEO
Credential:
Phone: 910-567-6194