MEDICARE: TRI RIVERS SURGICAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207XS0117X	Orthopaedic Surgery of the Spine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
4	207QS0010X	Sports Medicine (Family Medicine) Physician
5	363AS0400X	Surgical Physician Assistant
6	363L00000X	Nurse Practitioner
7	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1326104761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI RIVERS SURGICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	9104 BABCOCK BLVD
Second Line	:	SUITE 2120
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5818
Country	:	US
Telephone Number	:	412-367-0600
Fax Number	:	412-367-7079

Provider Business Practice Location Address
First Line	:	6998 CRIDER RD
Second Line	:	SUITE 110
City	:	MARS
State	:	PA
Zip	:	16046-2306
Country	:	US
Telephone Number	:	724-779-7000
Fax Number	:	412-367-7079

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. D. KELLY AGNEW
Credential	:	M.D.
Telephone Number	:	412-367-0600

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/03/2010

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