1043658537 NPI number — TRI-AREA COMMUNITY HEALTH

Table of content: (NPI 1043658537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043658537 NPI number — TRI-AREA COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-AREA COMMUNITY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRI-AREA COMMUNITY PHARMACY AT FERRUM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043658537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERRUM
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24088-0519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-365-9992
Provider Business Mailing Address Fax Number:
540-365-2718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 FERRUM MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRUM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24088-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-365-9992
Provider Business Practice Location Address Fax Number:
540-365-2718
Provider Enumeration Date:
06/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WERTH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
276-398-2292

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0201004119 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0201004119 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4138650002 . This is a "MEDICARE DME" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".