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General NPI Number Information
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NPI Number | 1992050173
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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 | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 711 S HEALTH PKWY SUITE 3
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City | THREE RIVERS
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State | MI
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Zip | 49093-9387
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Country | US
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Telephone | 269-273-9687
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Fax | 269-279-6461
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Provider Business Mailing Address
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Address Line | 711 S HEALTH PKWY L-7
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City | THREE RIVERS
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State | MI
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Zip | 49093-9387
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Country | US
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Telephone | 269-273-9687
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Fax | 269-279-6461
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | WILLIAM RUSSELL
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Credential |
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Telephone | 269-273-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 750020
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License Number State | MI
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