Provider Demographics
NPI:1508067414
Name:THREE RIVERS CLINIC, INC.
Entity Type:Organization
Organization Name:THREE RIVERS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ROBYN
Authorized Official - Last Name:BEHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-545-0200
Mailing Address - Street 1:6311 WAYZATA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1209
Mailing Address - Country:US
Mailing Address - Phone:952-545-0200
Mailing Address - Fax:952-545-6388
Practice Address - Street 1:6311 WAYZATA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1209
Practice Address - Country:US
Practice Address - Phone:952-545-0200
Practice Address - Fax:952-545-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty