Healthcare Provider Details

I. General information

NPI: 1447390091
Provider Name (Legal Business Name): TRI AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-0009
US

IV. Provider business mailing address

PO BOX 9 14558 DANVILLE PIKE
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2620
  • Fax: 276-398-3884
Mailing address:
  • Phone: 276-398-2292
  • Fax: 276-398-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0201003139
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003139
License Number StateVA

VIII. Authorized Official

Name: JIM WERTH
Title or Position: CEO
Credential:
Phone: 276-398-1200