Organization
TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Active
Other names
CommWell Health of Shallotte
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CLAY ELLISON (REVENUE CYCLE MANAGER)
(910) 567-7065
Entity
Organization
Contact information
Practice address
341A WHITEVILLE RD NW, SHALLOTTE, NC 28470-4507
(877) 935-5255
(910) 236-2118
Mailing address
PO BOX 340, FOUR OAKS, NC 27524-0340
(910) 567-6194
(910) 567-5342
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2804165
MEDICARE PIN
NC
01
—
341026
MEDICARE OSCAR
—
Enumeration date
09/17/2014
Last updated
03/27/2024
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