Healthcare Provider Details

I. General information

NPI: 1497062525
Provider Name (Legal Business Name): FCI THREE RIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 72 WEST
THREE RIVERS TX
78071
US

IV. Provider business mailing address

P.O. BOX 4000
THREE RIVERS TX
78071-0400
US

V. Phone/Fax

Practice location:
  • Phone: 361-786-3576
  • Fax: 361-786-5061
Mailing address:
  • Phone: 361-786-3576
  • Fax: 361-786-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberE6182
License Number StateTX

VIII. Authorized Official

Name: DR. DENNY KEITH THARP
Title or Position: CLINICAL DIRECTOR
Credential: D.O.
Phone: 361-786-3576