Provider Demographics
NPI:1508138785
Name:THREE RIVERS HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:THREE RIVERS HEALTH SYSTEM, INC
Other - Org Name:THREE RIVERS HEALTH SCHIMNOSKI FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-9601
Mailing Address - Street 1:711 S HEALTH PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9387
Mailing Address - Country:US
Mailing Address - Phone:269-278-1265
Mailing Address - Fax:269-273-2454
Practice Address - Street 1:711 S HEALTH PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9387
Practice Address - Country:US
Practice Address - Phone:269-278-1265
Practice Address - Fax:269-273-2454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI750020207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty