Healthcare Provider Details

I. General information

NPI: 1982194452
Provider Name (Legal Business Name): THREE RIVERS HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S ERIE ST
THREE RIVERS MI
49093-2060
US

IV. Provider business mailing address

711 S HEALTH PKWY STE L7
THREE RIVERS MI
49093-8354
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-9746
  • Fax:
Mailing address:
  • Phone: 269-273-6949
  • Fax: 269-273-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ANDREWS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 269-278-1145