Healthcare Provider Details

I. General information

NPI: 1346227584
Provider Name (Legal Business Name): TRI AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-3758
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2292
  • Fax: 276-398-3331
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: MS. DEBRA S. SHELOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-398-2292