Tri Area Community Health
Organization Active NPI Community/Retail Pharmacy · Laurel Fork, VA
NPI 1780647461 · NPPES record last updated Jul 25, 2024
Key facts
- NPI
- 1780647461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- TRI AREA COMMUNITY HEALTH
- Practice address
- 14558 Danville Pike
Laurel Fork, VA 24352-3758 - Phone
- (276) 398-2854
- Fax
- (276) 398-3331
- NPI assigned
- Apr 11, 2006
- Organization subpart
- No
Authorized official
- Name
- James Werth Jr., PH.D
- Title
- Ceo
- Phone
- (276) 398-2292
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 11
Practitioners 36
-
Kelsey Baugher, RD
-
Paige M Billman, PSY.D
-
Emily Kaye Blalock, PMHNP-BC
-
Zetta K Bowles, PSY. D.
-
Patricia L Bowman, MSSW
-
Brittany K Butler, PA-C
-
Brittany M Cockram, PSYD
-
Gabriel Lee Edmondson, D.O.
-
Carole Renee Everhart, DNP, FNP-C
-
Donna Gibson, FNP
-
April N Hazelwood, P.A.
-
Jacquelyn Alisha Hinkley, FNP-C
-
Pamela Ruth Hylton, LPC
-
Tiffany Michelle Jackson, FNP-C
-
Jenell Joines, FNP
-
Sarah Faith Knoeckel, FNP
-
Denise Marie, LCPC, ATR-BC,NBC-HWC
-
Jonathan J McNamara, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Tri Area Community Health |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 7, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211110000039 | VA | Part B Supplier - Pharmacy | 6204748296 |
1 other NPI on this enrollment Practice locations: Fries, VA; Laurel Fork, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
14558 Danville Pike
Laurel Fork, VA 24352-3758
Mailing address
PO Box 9
Laurel Fork, VA 24352-0009
Phone (276) 398-2292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008586560 | Medicaid | VA |
Other names
- Tri-Area Community Pharmacy at Laurel Fork
Other providers in Laurel Fork, VA
- Robert George Schuster
- Glen Edward Tate
- Tri Area Community Health
- Tri Area Community Health
- Tri Area Community Health
- Jacqueline L Webb
- Anna W Wright
All providers in Laurel Fork, VA · Community/Retail Pharmacy in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.