Provider Demographics
NPI:1588667679
Name:TRI RIVERS SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:TRI RIVERS SURGICAL ASSOCIATES, INC
Other - Org Name:TRI RIVERS PHYSICAL MEDICINE & REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D.
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-367-0600
Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:STE 2120
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-367-0600
Mailing Address - Fax:412-367-7079
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:STE 2120
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-367-0600
Practice Address - Fax:412-367-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QS0010X, 207XS0117X
PA207X00000X, 208100000X, 2081P2900X, 363AS0400X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006963180003Medicaid
PA0006963180002Medicaid
PA0006963180002Medicaid
PA031687Medicare ID - Type Unspecified
PA0135520002Medicare NSC