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General NPI Number Information
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NPI Number | 1124390307
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Entity Type | Organization
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Legal Business Name | THREE RIVERS HEALTH SYSTEM, INC
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1021 HILL ST STE 300
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City | THREE RIVERS
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State | MI
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Zip | 49093-2744
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Country | US
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Telephone | 269-858-3024
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Fax | 269-273-9040
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO / CHIEF FINANCIAL OFFICER
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Name | JEFFERY COSTELLO
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Credential |
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Telephone | 574-647-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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