Healthcare Provider Details

I. General information

NPI: 1134976186
Provider Name (Legal Business Name): TRI AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 FANCY GAP HWY
CANA VA
24317-3401
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 888-908-4788
  • Fax: 276-398-3331
Mailing address:
  • Phone: 276-398-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROL HASH
Title or Position: ACCOUNT RECEIVABLE MANAGER
Credential:
Phone: 276-398-1200