Healthcare Provider Details

I. General information

NPI: 1235897596
Provider Name (Legal Business Name): THREE RIVERS MEDICAL CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2673 HIGHWAY 644 STE 2
LOUISA KY
41230-5922
US

IV. Provider business mailing address

PO BOX 5009
BRENTWOOD TN
37024-5009
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-9572
  • Fax:
Mailing address:
  • Phone: 615-221-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA J FEY
Title or Position: SR. DIRECTOR REVENUE CYCLE
Credential:
Phone: 615-221-3641