Provider Demographics
NPI:1780647461
Name:TRI AREA COMMUNITY HEALTH
Entity Type:Organization
Organization Name:TRI AREA COMMUNITY HEALTH
Other - Org Name:TRI-AREA COMMUNITY PHARMACY AT LAUREL FORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
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 1:14558 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3758
Practice Address - Country:US
Practice Address - Phone:276-398-2854
Practice Address - Fax:276-398-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008586560Medicaid
4138650001Medicare ID - Type Unspecified