Provider Demographics
NPI:1073598801
Name:THREE RIVERS UROLOGY, P.C.
Entity Type:Organization
Organization Name:THREE RIVERS UROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-934-5520
Mailing Address - Street 1:3000 STONEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8317
Mailing Address - Country:US
Mailing Address - Phone:724-934-5520
Mailing Address - Fax:724-934-5533
Practice Address - Street 1:3000 STONEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8317
Practice Address - Country:US
Practice Address - Phone:724-934-5520
Practice Address - Fax:724-934-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA856528OtherHIGHMARK BLUE SHIELD
PA557825OtherAETNA
PA01594199Medicaid
PA=========OtherELDER HEALTH CARE
PA=========OtherCIGNA
PA557825OtherAETNA
PA=========OtherCIGNA