| Tri-state Community Health Center, Inc | |
|
261 Berkmore Pl Suite 1a Berkeley Springs WV 25411-6247 | |
| (304) 258-5790 | |
| (304) 258-3745 |
| Full Name | Tri-state Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 261 Berkmore Pl, Berkeley Springs, West Virginia |
| Authorized Official Name and Position | Sheila J Deshong (COO) |
| Authorized Official Contact | 3016785187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Community Health Center, Inc 109 Rayloc Dr Hancock MD 21750-1518 Ph: (301) 678-5187 | Tri-state Community Health Center, Inc 261 Berkmore Pl Suite 1a Berkeley Springs WV 25411-6247 Ph: (304) 258-5790 |
| NPI Number | 1083055081 |
|---|---|
| Provider Enumeration Date | 07/08/2013 |
| Last Update Date | 02/21/2014 |
| Medicare PECOS PAC ID | 9335057355 |
|---|---|
| Medicare Enrollment ID | O20130910000377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083055081 | NPI | - | NPPES |
| 511021 | Other | FQHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2291-3644 (West Virginia) | Primary |
| Provider Name | Edward Quarantillo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235146242 PECOS PAC ID: 4183753593 Enrollment ID: I20100624000988 |
| Provider Name | Stephanie Nicole Jarvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841567856 PECOS PAC ID: 9335314541 Enrollment ID: I20140529000365 |
| Provider Name | Liza Dawn Hiles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518296615 PECOS PAC ID: 0244476794 Enrollment ID: I20141003002221 |
| Provider Name | James Doyle Helsley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609904432 PECOS PAC ID: 5496930323 Enrollment ID: I20160510001361 |
| Provider Name | Ryan M. Hikes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609862358 PECOS PAC ID: 4587611710 Enrollment ID: I20210810000960 |
| Provider Name | Kristi Nicole Ashton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336845825 PECOS PAC ID: 0648634550 Enrollment ID: I20230911004237 |
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