Healthcare Provider Details

I. General information

NPI: 1588667679
Provider Name (Legal Business Name): TRI RIVERS SURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 BABCOCK BLVD STE 2120
PITTSBURGH PA
15237-5818
US

IV. Provider business mailing address

9104 BABCOCK BLVD STE 2120
PITTSBURGH PA
15237-5818
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-0600
  • Fax: 412-367-7079
Mailing address:
  • Phone: 412-367-0600
  • Fax: 412-367-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. D. KELLY AGNEW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 412-367-0600