Healthcare Provider Details

I. General information

NPI: 1053442848
Provider Name (Legal Business Name): TRI AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FERRUM MOUNTAIN RD
FERRUM VA
24088-2939
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 540-365-4469
  • Fax: 540-365-4272
Mailing address:
  • Phone: 276-398-2292
  • Fax: 276-398-3331

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: JAMES WERTH JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-398-2292