Provider Demographics
NPI:1497062525
Name:FCI THREE RIVERS
Entity Type:Organization
Organization Name:FCI THREE RIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-786-3576
Mailing Address - Street 1:P.O. BOX 4000
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:TX
Mailing Address - Zip Code:78071-0400
Mailing Address - Country:US
Mailing Address - Phone:361-786-3576
Mailing Address - Fax:361-786-5061
Practice Address - Street 1:HWY 72 WEST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:TX
Practice Address - Zip Code:78071
Practice Address - Country:US
Practice Address - Phone:361-786-3576
Practice Address - Fax:361-786-5061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6182261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center