Healthcare Provider Details

I. General information

NPI: 1386087831
Provider Name (Legal Business Name): APP THREE RIVERS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SW RAMSEY AVE
GRANTS PASS OR
97527-5554
US

IV. Provider business mailing address

PO BOX 748157
LOS ANGELES CA
90074-8157
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-7000
  • Fax:
Mailing address:
  • Phone: 541-789-5250
  • Fax: 541-789-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: STEFAN HARVEY
Title or Position: CFO
Credential:
Phone: 541-789-5190