Provider Demographics
NPI:1447390091
Name:TRI AREA COMMUNITY HEALTH
Entity Type:Organization
Organization Name:TRI AREA COMMUNITY HEALTH
Other - Org Name:TRI AREA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-398-2292
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:14558 DANVILLE PIKE
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 1:14558 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-0009
Practice Address - Country:US
Practice Address - Phone:276-398-2620
Practice Address - Fax:276-398-3884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-AREA COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
VA0201003139332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009104909Medicaid
VA008586560Medicaid
4138650001OtherMEDICARE DME
VA008586560Medicaid