MEDICARE: TRI RIVERS SURGICAL ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	PA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	PA
3	363AS0400X	Surgical Physician Assistant	PA
4	363L00000X	Nurse Practitioner	PA
5	207XS0117X	Orthopaedic Surgery of the Spine Physician
6	207QS0010X	Sports Medicine (Family Medicine) Physician
7	207X00000X	Orthopaedic Surgery Physician	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588667679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI RIVERS SURGICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	9104 BABCOCK BLVD
Second Line	:	STE 2120
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5818
Country	:	US
Telephone Number	:	412-367-0600
Fax Number	:	412-367-7079

Provider Business Practice Location Address
First Line	:	9104 BABCOCK BLVD
Second Line	:	STE 2120
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5818
Country	:	US
Telephone Number	:	412-367-0600
Fax Number	:	412-367-7079

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. D. KELLY AGNEW
Credential	:	M.D.
Telephone Number	:	412-367-0600

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/03/2010

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