NPIMap

Organization Active NPI

Tri-Care, PA

  • Clinical Child & Adolescent Psychologist
  • Winston Salem, NC
National Provider Identifier
1558477257
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
TRI-CARE, PA
Practice address
1702 S Hawthorne Rd
Winston Salem, NC 27103-4016
Phone
(336) 659-8301
Fax
(336) 659-9361
NPI assigned
Aug 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debbie N. Harrison-Church
Title
Practice Manager
Phone
(336) 659-8301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X NU Primary

Addresses

Primary practice location

1702 S Hawthorne Rd
Winston Salem, NC 27103-4016

Mailing address

1702 S Hawthorne Rd
Winston Salem, NC 27103-4016
Phone (336) 659-8301

Other identifiers 1

IdentifierTypeStateIssuer
0204WOtherNCBLUECROSSBLUESHIELDGRP#

National Provider Directory

National Provider Directory

Locations

1702 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 659-8301

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558477257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034016",
            "telephone_number": "336-659-8301",
            "fax_number": "336-659-9361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 S HAWTHORNE RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034016",
            "telephone_number": "336-659-8301",
            "fax_number": "336-659-9361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARRISON-CHURCH",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "336-659-8301",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELDGRP#",
            "identifier": "0204W",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.