MEDICARE: TRI COUNTY COMMUNITY HEALTH COUNCIL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q390930001	OTHER		MEDICARE PART B
3	341959	OTHER		MEDICARE PART A

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780999458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI COUNTY COMMUNITY HEALTH COUNCIL INC

Provider Business Mailing Address
First Line	:	PO BOX 227
Second Line	:
City	:	NEWTON GROVE
State	:	NC
Zip	:	28366-0227
Country	:	US
Telephone Number	:	910-567-6194
Fax Number	:	910-567-4389

Provider Business Practice Location Address
First Line	:	6934 BEACH DR SW STE 1
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-5797
Country	:	US
Telephone Number	:	910-579-1300
Fax Number	:	910-579-9625

Authorized Official
Title or Position	:	CEO
Name	:	PAMELA M TRIPP
Credential	:
Telephone Number	:	910-567-7004

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	02/01/2018

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Directions to “TRI COUNTY COMMUNITY HEALTH COUNCIL INC ” Practice Location

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