Healthcare Provider Details

I. General information

NPI: 1326952078
Provider Name (Legal Business Name): TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S RAIFORD ST
SELMA NC
27576-3155
US

IV. Provider business mailing address

6114 US HIGHWAY 301 S
FOUR OAKS NC
27524-7417
US

V. Phone/Fax

Practice location:
  • Phone: 910-567-6194
  • Fax:
Mailing address:
  • Phone: 910-753-4630
  • 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: SR DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 910-567-7065