Tri Area Community Health At Laurel Fork | |
14558 Danville Pike Laurel Fork VA 24352-3758 | |
(276) 398-2292 | |
(276) 398-3331 |
Full Name | Tri Area Community Health At Laurel Fork |
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Speciality | Clinic/Center |
Location | 14558 Danville Pike, Laurel Fork, Virginia |
Authorized Official Name and Position | Debra S. Shelor (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2763982292 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Tri Area Community Health At Laurel Fork Po Box 9 Laurel Fork VA 24352-0009 Ph: (276) 398-2292 | Tri Area Community Health At Laurel Fork 14558 Danville Pike Laurel Fork VA 24352-3758 Ph: (276) 398-2292 |
NPI Number | 1346227584 |
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Provider Enumeration Date | 12/29/2005 |
Last Update Date | 09/09/2010 |
Medicare PECOS PAC ID | 6204748296 |
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Medicare Enrollment ID | O20030930000011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346227584 | NPI | - | NPPES |
007608942 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Laurel Fork Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1205 Stone Mountain Road, Laurel Fork, VA 24352 Phone: 276-398-2532 Fax: 276-398-2534 |