Provider Demographics
NPI:1275559676
Name:THREE RIVERS ONCOLOGY
Entity Type:Organization
Organization Name:THREE RIVERS ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-327-0120
Mailing Address - Street 1:1724 FAIRVIEW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7872
Mailing Address - Country:US
Mailing Address - Phone:406-327-0120
Mailing Address - Fax:406-327-0117
Practice Address - Street 1:1724 FAIRVIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7872
Practice Address - Country:US
Practice Address - Phone:406-327-0120
Practice Address - Fax:406-327-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5675300001OtherDMER NUMBER
MT0150841Medicaid
MT5675300001OtherDMER NUMBER