Provider Demographics
NPI:1194908491
Name:TRI AREA COMMUNITY HEALTH
Entity type:Organization
Organization Name:TRI AREA COMMUNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-398-2854
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-0009
Mailing Address - Country:US
Mailing Address - Phone:276-398-2292
Mailing Address - Fax:276-398-3331
Practice Address - Street 1:140 CHRISTIANSBURG PIKE NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-3742
Practice Address - Country:US
Practice Address - Phone:540-745-9290
Practice Address - Fax:540-745-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194908491Medicaid
VA1194908491Medicaid
VAC01125Medicare PIN