Provider Demographics
NPI:1053442848
Name:TRI AREA COMMUNITY HEALTH
Entity Type:Organization
Organization Name:TRI AREA COMMUNITY HEALTH
Other - Org Name:TRI AREA COMMUNITY HEALTH AT FERRUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:276-398-2292
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 1:180 FERRUM MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FERRUM
Practice Address - State:VA
Practice Address - Zip Code:24088-2939
Practice Address - Country:US
Practice Address - Phone:540-365-4469
Practice Address - Fax:540-365-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053442848Medicaid
VA010355125Medicaid
VA491872Medicare Oscar/Certification