Healthcare Provider Details

I. General information

NPI: 1093113151
Provider Name (Legal Business Name): THREE RIVERS HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S HEALTH PKWY
THREE RIVERS MI
49093-8358
US

IV. Provider business mailing address

701 S HEALTH PKWY MEDICAL STAFF OFFICE
THREE RIVERS MI
49093-8352
US

V. Phone/Fax

Practice location:
  • Phone: 269-279-5240
  • Fax: 269-273-9060
Mailing address:
  • Phone: 269-273-9789
  • Fax: 269-273-9611

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: WILLIAM RUSSELL
Title or Position: CEO
Credential:
Phone: 269-273-9601