=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447390091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI AREA COMMUNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14558 DANVILLE PIKE
-----------------------------------------------------
City | LAUREL FORK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24352-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-398-2620
-----------------------------------------------------
Fax | 276-398-3884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9 14558 DANVILLE PIKE
-----------------------------------------------------
City | LAUREL FORK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24352-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-398-2292
-----------------------------------------------------
Fax | 276-398-3331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JIM WERTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 276-398-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201003139
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0201003139
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------